Relationship between fibrinogen levels and cardiovascular events in patients receiving percutaneous coronary intervention: a large single-center study
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Updated: Jan 26, 2026
Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Ping Jiang1, Zhan Gao1, Wei Zhao2
1Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Insights
Fibrinogen levels are linked to 2-year mortality in patients undergoing percutaneous coronary intervention (PCI). However, fibrinogen does not improve risk prediction beyond traditional factors for these patients.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Risk Prediction
Background:
- Uncertainty exists whether fibrinogen is a causal risk factor or a marker of comorbidities in percutaneous coronary intervention (PCI) patients.
- Investigating fibrinogen's role in predicting adverse outcomes post-PCI is crucial for risk stratification.
Purpose of the Study:
- To determine the association between baseline fibrinogen levels and 2-year all-cause mortality in patients undergoing PCI.
- To evaluate the added predictive value of fibrinogen to traditional risk factors for mortality after PCI.
Main Methods:
- A cohort of 6293 patients undergoing PCI with measured baseline fibrinogen were stratified into low, medium, and high fibrinogen groups.
- Multivariate Cox regression and C-statistic analyses were used to identify predictors and assess the discriminative value of fibrinogen.
- Integrated discrimination improvement (IDI) was calculated to quantify the additional predictive information provided by fibrinogen.
Main Results:
- The 2-year all-cause mortality rate was 1.2%, with significantly higher rates in the high fibrinogen group.
- Fibrinogen was independently associated with all-cause mortality (HR 1.339, P=0.005), alongside traditional risk factors.
- Adding fibrinogen to a traditional risk model increased the area under the curve from 0.776 to 0.787, but this increase was not statistically significant (IDI P=0.889).
Conclusions:
- Fibrinogen is associated with 2-year all-cause mortality in patients undergoing PCI.
- Fibrinogen does not provide significant additional predictive information for mortality beyond established traditional risk factors in this population.
Background:
It is currently unclear if fibrinogen is a risk factor for adverse events in patients receiving percutaneous coronary intervention (PCI) or merely serves as a marker of pre-existing comorbidities and other causal factors. We therefore investigated the association between fibrinogen levels and 2-year all-cause mortality, and compared the additional predictive value of adding fibrinogen to a basic model including traditional risk factors in patients receiving contemporary PCI.
Methods:
A total of 6293 patients undergoing PCI with measured baseline fibrinogen levels were enrolled from January to December 2013 in Fuwai Hospital. Patients were divided into three groups according to tertiles of baseline fibrinogen levels: low fibrinogen, <2.98 g/L; medium fibrinogen, 2.98 to 3.58 g/L; and high fibrinogen, ≥3.58 g/L. Independent predictors of 2-year clinical outcomes were determined by multivariate Cox proportional hazards regression modeling. The increased discriminative value of fibrinogen for predicting all-cause mortality was assessed using the C-statistic and integrated discrimination improvement (IDI).
Results:
The 2-year all-cause mortality rate was 1.2%. It was significantly higher in the high fibrinogen compared with the low and medium fibrinogen groups according to Kaplan-Meier analyses (1.7% vs. 0.9% and 1.7% vs. 1.0%, respectively; log-rank, P = 0.022). Fibrinogen was significantly associated with all-cause mortality according to multivariate Cox regression (hazard ratio 1.339, 95% confidence interval: 1.109-1.763, P = 0.005), together with traditional risk factors including age, sex, diabetes mellitus, left ventricular ejection fraction, creatinine clearance, and low-density lipoprotein cholesterol. The area under the curve for all-cause mortality in the basic model including traditional risk factors was 0.776, and this value increased to 0.787 when fibrinogen was added to the model (IDI = 0.003, Z = 0.140, P = 0.889).
Conclusions:
Fibrinogen is associated with 2-year all-cause mortality in patients receiving PCI, but provides no additional information over a model including traditional risk factors.
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