The relationship of fibrinogen albumin ratio with clinical results, Syntax2 and residual Syntax 2 Score in patients with percutaneous coronary intervention and multiple coronary artery disease

Background: Fibrinogen is a positive acute phase reactant, and its plasma concentration increases in inflammatory conditions. The strong correlation of fibrinogen with plasma viscosity is also known. High fibrinogen levels increase tendency to atherosclerosis both fibrinogen degradation by products and increased plasma viscosity. Albumin is a negative acute phase reactant, and its plasma concentration decreases in inflammatory processes. Epidemiological studies have shown that there is a correlation between cardiovascular mortality low plasma level of the albumin. The purpose of this study is to show the clinical importance of fibrinogen/albumin ratio as an inflammatory parameter indicating the severity and extent of atherosclerosis. Materials and Methods: A total of 370 patients, aged between 36-95 years, who applied to Akdeniz University Medical Faculty Hospital between July 2020 and August 2021 with the diagnosis of stable angina pectoris according to the "European Society of Cardiology" 2019 guideline and acute myocardial infarction according to the 2018 guideline, were included in the study. The severity and extent of atherosclerosis were evaluated with Syntax-2 score and residual Syntax-2 score. According to the Syntax-2 score, the patients were divided into two groups as low Syntax-2 score (n: 204) and high Syntax-2 score (n: 166). It was tried to form groups with similar characteristics in terms of demographic and clinical characteristics. The fibrinogen/albumin ratio was compared between the two groups. Results: The neutrophil / lymphocyte ratio was 2.61±1.79 in the low Syntax2 score group and 3.4±3.3 (p<0.001) in the high Syntax-2 group. The fibrinogen / albumin ratio was 82.55±31.37 in the low Syntax-2 score group, and 97.44±34.75 (p<0.001) in the high Syntax-2 group. CRP was 0.87±2.15 mg/dl in the low Syntax2 score group and 1.29±2.72 mg/dl (p<0.001) in the high Syntax-2 group. According to the residual Syntax-2 score, neutrophil / lymphocyte, fibrinogen, albumin, fibrinogen / albumin and CRP were found to be statistically significant. In the correlation analysis, there was a very weak positive correlation between the neutrophil / lymphocyte ratio and the Syntax-2 score, and it was statistically significant (r=0.155, p=0.003). There is a very weak positive correlation between the fibrinogen / albumin ratio and the Syntax-2 score, and it is statistically significant (r=0.220, p<0.001). There was a very weak positive correlation between CRP and Syntax-2 score and it was statistically insignificant (r=0.086, p=0.1). The correlation between fibrinogen/albumin ratio and neutrophil / lymphocyte ratio was very weakly positive and statistically significant (r=0.130, p=0.012). As a result of clinical follow-ups, it was shown that there is a statistically significant relationship between Syntax-2 score and decompensated congestive heart failure, reinfarction, revascularization and death (p<0.001). In the multivariate logistic regression analysis performed to find the factors affecting the Syntax-2 score variable, the most significant variable among the variables was the fibrinogen / albumin ratio after smoking [p=0.02, 95% CI (1.005-1.023)]. In the ROC analysis of the data, Fibrinogen / albumin ratio values of 81.6% and above indicate the severity of coronary artery disease with 65.9% sensitivity and 60.7% specificity. Conclusions: Plasma fibrinogen / albumin ratio in patients with high Syntax2 score is statistically significantly higher than that found in those with a low Syntax-2 score. Fibrinogen / albumin levels were a strong predictor of the extent and severity of coronary artery disease.