Relationship between the Fibrinogen/Albumin Ratio and Microvascular Perfusion in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Elevated Myocardial Infarction: A Prospective Study

Kaplangoray, Mustafa; Toprak, Kenan; Cicek, Omer Faruk; Deveci, Edhem

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Arquivos Brasileiros de Cardiologia

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ORIGINAL ARTICLE • Arq. Bras. Cardiol. 120 (11) • Oct 2023 • https://doi.org/10.36660/abc.20230002 copy

Relationship between the Fibrinogen/Albumin Ratio and Microvascular Perfusion in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Elevated Myocardial Infarction: A Prospective Study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Correct TIMI frame count (CTFC), myocardial blush grade (MBG), and ST-segment resolution (STR) are parameters used to evaluate reperfusion at the microvascular level in patients that have undergone primary percutaneous coronary intervention (pPCI). Fibrinogen-to-albumin ratio (FAR) has been associated with thrombotic events in patients with ST-elevation myocardial infarction (STEMI) and chronic venous insufficiency.

Objectives

To investigate the relationship of FAR with CTFC, MBG, and STR. Methods: The study included 167 consecutive patients who underwent successful pPCI for STEMI and achieved TIMI-3 flow. The cases were divided into two groups, high (>0.0765) and low FAR (≤0.0765), according to the cut-off value of this parameter in the receiver operator characteristic analysis (ROC). STR, CTFC, and MBG were used to evaluate myocardial reperfusion. P values<0.05 were considered statistically significant.

Results

CTFC value, SYNTAX score, neutrophil/lymphocyte ratio, low-density lipoprotein, glucose, and peak cTnT were significantly higher, whereas STR, MBG, and LVEF were lower in the high FAR group. Spearman’s correlation analysis revealed a significant relationship between the FAR and STR (r=-0.666, p<0.001), MBG (-0.523, p<0.001), and CTFC (r=0.731, p≤0.001). According to the logistic regression analysis, FAR, glucose, peak cTnT, and pain to balloon time were the most important independent predictors of MBG 0/1, CTFC>28, and STR<50%).ROC analysis revealed that the cut-off value of FAR≥0.0765 was a predictor of incomplete STR with a sensitivity of 71.9 % and a specificity of 69.8 %, MBG0/1 with a sensitivity of 72.6 % and a specificity of 68.6 %, and CTFC >28 with a sensitivity of 76 % and a specificity of 65.8 %.

Conclusions

FAR is an important independent predictor of microvascular perfusion in patients undergoing pPCI for STEMI.

ST-Elevation Myocardial Infarction; Fbrinogen-to-Albumin Ratio; Myocardial Perfusion Imaging; Primary Percutaneous Coronary Intervention

Characteristic	High FAR (n=71)	Low FAR (n=96)	p
Age, years	61.4 ±10.6	57.8±11.2	0.043
Males, n (%)	40 (56.3%)	56 (58.3%)	0.797
BMI, kg/m ²	28.2±3.8	27.3±3.4	0.105
Smoking, n (%)	29 (40.8%)	38 (39.6%)	0.869
Hypertension, n (%)	26 (36.6%)	23 (24.0%)	0.076
Diabetes, n (%)	35 (49.3%)	32 (33.3%)	0.037
SBP, mmHg	128.3±18.7	126.6±18.9	0.207
DBP, mmHg	80.9±13.4	81.2±12.6	0.917
Heart rate, /min	77.7±12.6	75.1±13.9	0.212
Pain-to-balloon time (min)	70.6±20.1	64.5±23.8	0.076
SYNTAX score	19.4±6.2	16.9±7.3	0.004
LVEF,%	41.8±6.5	46.4±6.0	<0.001
Killip class
Class 1, n	54 (76.1%)	88 (91.7%)	0.005
Class ≥2, n	17 (23.9%)	8 (8.3%)	0.005
Medical history
Acetylsalicylic acid	23 (31.5%)	23 (24.5%)	0.313
Statin	15 (20.5%)	19 (20.2%)	0.957
Beta-blocker	23 (31.5%)	20 (21.3%)	0.134
ACEI/ARB	27 (37.0%)	25 (26.6%)	0.150
Laboratory findings
WBC, ( x10³/ µL)	12.3 (10.1-14.9)	12.0 (10.9-13.9)	0.965
Neutrophil/Lymphocyte ratio	2.9 (2.1-3.7)	1.9 (1.3-2.9)	< 0.001
Hemoglobin, g/l	13.9 (12.5-15.1)	14.2 (13-15.3)	0.495
Platelet count, ( x10³/ µL)	256 (164-354)	247 (198-319)	0.245
Glucose	172 (145-201)	135 (122-175)	<0.001
ALT, IU/l	35.7±21.2	36.1±27.7	0.938
AST, IU/l	29.7±18.8	28.5±16.2	0.658
Creatinine, μmol/l	0.95±0.25	0.94±0.26	0.759
Blood urea nitrogen, mmol/l	39.3±11.7	35.7±12.2	0.054
Total cholesterol, mmol/l	199 (185-214)	196 (178-205)	0.149
HDL, mmol/l	35 (33-41)	37 (33-41)	0.214
LDL, mmol/l	152 (136-161)	139 (122-150)	<0.001
Triglyceride, mmol/l	178 (156-199)	177 (155-197)	0.461
İnfarct-related artery
LAD, n (%)	32 (45.1%)	43 (44.8%)	0.609
CX,n (%)	18 (25.4)	19 (21.3)
RCA, n (%)	21 (29.6)	34 (35.4)

	High FAR	Low FAR	p
Myocardial Blush grade
MBG 0/1	44 ( 62 %)	18 (18.8 %)	<0.001
MBG 2/3	27 (38%)	78 (81.3)	<0.001
Corrected TIMI frame count
>28	37 (52.1 %)	13 (13.5 %)	<0.001
≤28	34 (47.9 %)	83 (86.5 %)	<0.001
ST-segment resolution
STR<50%	46 (64.8 %)	18 (18.8 %)	<0.001
STR≥50%	25 (35.2 %)	78 (81.3 %)	<0.001
Enzymatic infarct size
Peak cTnT, pg/ml	5100 (3410-7890)	1670 (1022-4092)	<0.001
Peak CK-MB, U/L	255 (201-300)	133 (98-229)	<0.001

Variables	FAR
Variables	r	p
NLR	0,389	<0,001
STR	-0,666	<0,001
Syntax Score	0,223	0,004
LVEF	-0,398	<0,001
Peak Troponın level	0,582	<0,001
CTFC	0,731	<0,001
MBG	-0,523	<0,001
Pain-to-balloon time (min)	0,158	0,041
LDL	0,245	<0,001
Glucose	0,387	<0,001

Variables	MBG 0/1		CTFC>28		STR<50%
Variables	Adjusted OR (95% CI)	p	Adjusted OR (95% CI)	p	Adjusted OR (95% CI)	p
FAR	0.219 (0.090-0.531)	<0.001	0.230(0.093-0.567)	<0.001	0.097 (0.037-0.250)	<0.001
Age	0.970 (0.931-1.10)	0.143	0.089(0.949-1.030)	0.586	1.006 (0.970-1.044)	0.750
DM	0.982(0.411-2.346)	0.967	1.448 (0.587-3.573)	0.422	0.867 (0.375-2.002)	0.738
SYNTAX	1.046 (0.978-1.119)	0.190	0.909 (0.854-0.967)	0.002	0.977 (0.925-1.032)	0.403
NLR	0.710(0.520-0.970)	0.031	0.989 (0.875-1.119)	0.864	0.929 (0.758-1.138)	0.476
Glucose	1.010 (0.989-1.022)	0.023	0.991 (0.982-1.001)	0.048	1.013(1.002-1.024)	0.018
LDL-C	1.007(0.988-1.027)	0.463	0.999 (0.981-1.017)	0.900	1.001(0.985-1.018)	0.881
Peak cTnT	1.010(.0997-1.028)	0.041	1.000 (0.988-1.012)	<0.001	1.001 (1.000-1.002)	<0.001
Pain-to-balon time	1.001(0.982-1.020)	0.025	1.035 (1.024-1.046)	0.002	0.977(0.960-0.994)	0.007

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[1] Mailing Address: Mustafa Kaplangoray • Bilecik Şeyh Edebali University Faculty of Medicine - Department of Cardiology, Pelitözü Mah. Fatih Sultan Mehmet Bulvarı No:27 11100 Merkez/BİLECİK Email: mkaplangoray@gmail.com