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Prognostic Value of Fibrinogen-to-Albumin Ratio in Coronary Three-Vessel Disease
Xinsheng Li1, Zhongzhen Wang1, Yifan Zhu2
1Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China.
Insights
The fibrinogen-to-albumin ratio (FAR) can predict adverse outcomes in patients with coronary three-vessel disease (TVD). A higher FAR indicates increased risk of all-cause mortality and major adverse cardiac and cerebrovascular events (MACCEs).
Area of Science:
- Cardiology
- Biomarkers
- Prognostic research
Background:
- Coronary three-vessel disease (TVD) poses significant risks for adverse cardiovascular events.
- Identifying reliable prognostic markers is crucial for managing TVD patients.
- The fibrinogen-to-albumin ratio (FAR) is an emerging biomarker with potential clinical utility.
Purpose of the Study:
- To evaluate the prognostic value of the fibrinogen-to-albumin ratio (FAR) in patients with coronary three-vessel disease (TVD).
- To determine if FAR can improve the prediction of adverse outcomes beyond traditional risk factors.
Main Methods:
- Retrospective cohort study of 4061 TVD patients (2013-2018).
- FAR levels were analyzed, with a cut-off of 0.084 identified.
- Multivariate Cox regression, C-index, NRI, and IDI were used to assess FAR's predictive ability for all-cause mortality and MACCEs.
Main Results:
- Patients with high FAR (≥0.084) had significantly higher rates of all-cause mortality (adjusted HR 1.68) and MACCEs (HR 1.28) compared to those with low FAR (<0.084).
- FAR significantly improved the predictive discrimination and risk reclassification for both all-cause mortality and MACCEs (C-index 0.72, NRI 0.3778, IDI 0.0098).
Conclusions:
- Elevated FAR is associated with increased risk of all-cause mortality and MACCEs in TVD patients.
- FAR serves as a valuable independent prognostic marker for TVD.
- Incorporating FAR into risk assessment models can enhance prognostic accuracy for TVD patients.
Objective:
To investigate the prognostic value of fibrinogen-to-albumin ratio (FAR) in the adverse outcomes of patients with coronary three-vessel disease (TVD).
Methods:
A total of 4061 patients with TVD between 2013 and 2018 were analyzed in this retrospective cohort study. The best cut‑off value of the FAR determined by receiver operating characteristic (ROC) curve analysis was 0.084. 2782 (68.5%) patients were in the low FAR group (FAR < 0.084) and 1279 (31.5%) patients were in the high FAR group (FAR ≥ 0.084), respectively. Three multivariate Cox proportional hazards models were applied to determine the associations of FAR with clinical outcomes. The concordance index (C-index), net reclassification index (NRI), and integrated discrimination improvement (IDI) were used to assess the incremental predictive value of the FAR and baseline models with respect to the additive effects of the established traditional risk factors on the discrimination of clinical outcomes. The primary endpoint was all-cause mortality. The secondary endpoint was major adverse cardiac and cerebrovascular events (MACCEs).
Results:
The median follow-up duration was 2.4 years (range 1.1-4.1 years). Multivariate Cox regression analyses showed that the incidence of all-cause mortality (4.7% vs 2.2%, adjusted hazard ratio [HR] 1.68, 95% confidence interval [CI] 1.12-2.52, p=0.011) and MACCE (34.6% vs 27.3%, HR 1.28, 95% CI 1.13-1.46, p<0.001) were significantly higher in the high FAR group compared to the low FAR group. The C-index was 0.72 (p < 0.001), the value of NRI was 0.3778 (p < 0.001), and the value of IDI was 0.0098 (p < 0.001) for those with FAR. After FAR was added to the traditional model, the discrimination and risk reclassification ability can be significantly improved for all-cause mortality. The similar results were found for MACCE.
Conclusion:
Higher level of FAR was associated with all-cause mortality and MACCE among patients with TVD. FAR could help to improve the prognostic performance of the traditional risk factors for TVD patients.
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