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Fibrinogen-to-albumin ratio independently predicts left ventricular aneurysm in STEMI patients: a retrospective
Qinshuo Zhao1, Mengying He1, Dong Hu2
1Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.
Insights
High fibrinogen-to-albumin ratio (FAR) independently predicts left ventricular aneurysm (LVA) risk in ST-elevation myocardial infarction (STEMI) patients. A validated model incorporating FAR improves LVA prediction after primary percutaneous coronary intervention.
Area of Science:
- Cardiology
- Biomarkers
- Predictive Modeling
Background:
- Left ventricular aneurysm (LVA) is a serious complication of ST-elevation myocardial infarction (STEMI).
- The fibrinogen-to-albumin ratio (FAR) is an inflammatory biomarker, but its predictive role in LVA is not well understood.
Purpose of the Study:
- To investigate the association between FAR and LVA risk in STEMI patients.
- To develop and validate a predictive model for LVA using FAR and other clinical factors.
Main Methods:
- Retrospective cohort study of 1,245 STEMI patients undergoing primary percutaneous coronary intervention (pPCI).
- Temporal validation using an independent cohort of 310 STEMI patients.
- Restricted cubic spline analysis, LASSO, and multivariable logistic regression for analysis.
- Development and validation of a prediction model using ROC curves, calibration curves, DCA, and nomogram.
Main Results:
- Elevated FAR was independently associated with increased LVA risk (OR = 2.10).
- A combined model (FAR, LVEF, NT-proBNP) showed high discrimination (AUC = 0.933) in the development cohort.
- The model demonstrated excellent discriminative performance (AUC = 0.934) and acceptable calibration in the validation cohort.
Conclusions:
- Elevated FAR is an independent predictor of LVA in STEMI patients post-pPCI.
- The developed prediction model is stable and effective for LVA risk assessment in STEMI patients.
Background:
Left ventricular aneurysm (LVA) is a severe complication following acute ST-elevation myocardial infarction (STEMI) that worsens prognosis. The fibrinogen-to-albumin ratio (FAR) is an inflammatory biomarker with prognostic value in cardiovascular disease, but its role in predicting LVA remains unclear.
Methods:
We conducted a retrospective cohort study including 1,245 STEMI patients undergoing primary percutaneous coronary intervention (pPCI) at Renmin Hospital of Wuhan University between January 2020 and December 2025. An additional temporally independent cohort of 310 STEMI patients admitted between January 1, 2026 and June 15, 2026 was used for temporal validation. Restricted cubic spline analysis (RCS) was performed to examine the relationship between continuous FAR and LVA risk. Least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression were used for variable selection and association analysis. Receiver operating characteristic (ROC) curve, calibration curve, decision curve analysis (DCA), and nomogram were used to develop and validate the prediction model.
Results:
In the development cohort, high FAR was independently associated with LVA (OR = 2.10, 95% CI: 1.09-4.04, P = 0.027). The combined model incorporating FAR, left ventricular ejection fraction (LVEF), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) demonstrated high discrimination, with an area under the curve (AUC) of 0.933 (95% CI: 0.914-0.952). In the temporal validation cohort, the combined model retained excellent discriminative performance, with an AUC of 0.934 (95% CI: 0.894-0.974), and showed acceptable calibration, with a mean absolute error of 0.021 after 1,000 bootstrap resamples.
Conclusion:
Elevated FAR is independently associated with an increased risk of LVA in patients with STEMI following pPCI. Temporal validation further supported the stability of the prediction model in a later patient cohort.
