Relationship between fibrinogen/albumin ratio and syntax scores in patient with non ST elevation myocardial infarction

ABSTRACT Background: Fibrinogen is a positive acute phase reactant its plasma concentration increases in case of inflammatory processes. Strong correlation between fibrinogen levels and plasma viscosity is also well-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 level decreases during the 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/albümin ratio as an inflammatory parameter indicating the severity and extent of atherosclerosis. Material and methods: 83 patients between 40-93 ages who were admitted to Dicle University school of Medicine Department of Cardiology between January and September 2015 and diagnosed with acute coronary syndrome according to non-ST elevated myocardial infarction guidelines published on 2013 by European Society of Cardiology are included in this study. The severity and extent of atherosclerosis was assessed using Syntax and Gensini scores. Patients were divided into two groups according to their Syntax scores as medium-high Syntax score (n=23) and low Sytnax scores (n=60). Groups were matched on demographic and clinical characteristics. Fibrinojen / albümin ratio of the groups were compared. Results: Neutrophil / lymphocyte ratio was 3.68 ± 3.1 in low Syntax score group and 7:04 ± 4.27 in the mid-high Syntax score group, respectively (p <0.001). Fibrinogen / albumin ratio was 80.71 ± 30.3 in low Syntax score group and 120 ± 49.72 in the mid-high Syntax score group, respectively (p <0.001). D-dimer level was 0.63 ± 0.87 mg/dl in low Syntax score group, and 1.49 ± 1.18 mg/dl in the mid-high Syntax score group, respectively (p<0.001). Albumin, fibrinogen, and D-dimer were found to be statistically meaningful according to Gensini score, however fibrinojen / albumin ratio was not statistically significant with a marginal p-value (p=0.05). In correlation analysis, neutrophil / lymphocyte ratio and Syntax score showed a statistically significant weak positive correlation (r = 0.450, p <0.001). D-dimer and Syntax score were also statistically significantly correlated with a weak association (r = 0.406, p <0.001). Fibrinogen / albumin ratio and Syntax score again demonstrated a weak positive correlation (r = 0.496, p <0.001). Neutrophil / lymphocyte ratio and fibrinogen / albumin ratio were very weakly correlated, however it remained statistically significant as well (r = 0.219, p = 0.04). In multivariate logistic regression analysis of factors affecting the Syntax score, the most significant variable was found to be fibrinogen / albumin ratio [p = 0.01, 95% CI (1005-1042)]. In ROC analysis, fibrinogen / albumin ratio values of 85 and above demonstrated 83% sensitivity and 68% specificity in indicating the severity of coronary artery disease. Conclusions: Plasma fibrinogen / albumin ratio in patients with moderate-to-high Syntax score is statistically significantly higher than that found in those with a low Syntax score. Fibrinogen / albumin levels were a strong predictor of the extent and severity of coronary artery disease. Keywords: Fibrinogen, Albumin, Fibrinogen / albumin ratio, Neutrophil / lymphocyte ratio, D-dimer, Syntax Score, Gensini Score