| Objective:Fibrinogen/albumin ratio(FAR)is an easily measurable novel inflammatory index that has been found to be associated with atherosclerosis.In this study,the aim was to assess whether FAR was associated with extent and complexity of coronary artery disease as assessed by the Gensini score and the number of coronary artery lesions,analyze the difference of FAR level in different clinical types of coronary heart disease and its correlation with established systemic inflammatory biomarkers,simultaneously,discuss the usefulness of FAR in predicting GS in patients who suffer from CHD.Methods:This study retrospectively selected 391 CHD patients who were treated for the first time with CAG in the Cardiovascular and Cerebrovascular Branch Hospital,which is affiliated of Yan’an University from January 2020 to January 2021due to chest tightness and other precordial discomfort symptoms.In period of those time,242 Non-CHD controls with negative coronary CTA scans were included.Collect the clinical data,laboratory test indicators,and angiography data of the above research subjects when they are admitted to the hospital,and record them truthfully.Calculate the neutrophil/lymphocyte ratio(NLR)and platelet/lymphocyte ratio(PLR)based on the NEUT,PLT,LY,and high-sensitivity C-reactive protein(hs-CRP)determined by blood routine testing of all patients.Similarly,Calculate the fibrinogen/albumin ratio(FAR)based on the serum fibrinogen(FIB)and albumin(ALB)levels measured in the blood coagulation series of tests.According to the clinical manifestations of patients with precordial discomfort at the time of admission,ECG,myocardial injury,myocardial enzyme spectrum and other auxiliary examination results,as well as the CAG operation records,CHD patients are divided into three groups according to clinical types:stable angina group(SAP group)with95 cases,aged 43 to 86 years old;199 cases in NSTE-ACS group,Aged 47 to 87 years old;97 cases in the STE-ACS group,aged 40 to 83 years old.The CHD patients were divided into low GS group(GS<20 points)108 cases and high GS group(GS≥20points)283 cases with Gensini score(GS)of 20 as the cut-off point.According to the FAR cutoff value of 6.16 when the value of high GS is predicted to be maximum,CHD patients were divided into high FAR group(FAR≥6.16)255 cases,and low FAR group(FAR<6.16)136 cases.Comparative analysis:1.Different clinical type group(SAP group、NSTE-ACS group、STE-ACS group与Non-CHD controls):⑴Differences in basic characteristics of four group patients;⑵Differences in FAR and different inflammatory biomarkers(hs-CRP,NLR,PLR)Whether there were differences among these groups;⑶Comparison of differences with GS among three CHD clinical type groups.2.Spearman correlation analysis analyzes the correlation between FAR and different inflammatory biomarkers(hs-CRP,NLR,PLR).3.FAR and severity of coronary artery disease:⑴In different vascular disease groups,analysis the differences of FAR and different inflammatory biomarkers(FIB,ALB,hs-CRP,NLR,PLR),the same as GS.⑵In low GS group and high GS group.(1)Comparison with differences of general clinical data;(2)Were there a difference among FAR and different inflammatory biomarkers(hs-CRP,NLR,PLR),GS between the low GS group and the high GS group.4.Spearman correlation analysis analyzes the correlation between FAR,different inflammatory biomarkers(hs-CRP,NLR,PLR)and GS in CHD patients.5.The value of FAR in predicting the severity of coronary artery disease and its clinical application:⑴Using binary Logistic regression to analyze Whether FAR,different inflammatory biomarkers(hs-CRP,NLR,PLR)and other related indicators were independent risk factors for high GS.⑵Evaluate the predictive value of FAR and hs-CRP alone and the combination of the two inflammatory biomarkers for high GS by ROC curve.⑶The value of clinical application:comparing the difference of GS and the incidence rate of three-vessel disease and STE-ACS between the high FAR and low FAR group.Result:1.No significant differences were noted in the proportion of males,smokers,patients with hypertension and patients with diabetes mellitus.There were also no significant differences in age,BMI,total cholesterol(TC),and aminotransferase(ALT),creatinine(CRE)among the four groups of different clinical types(above P>0.05);TG levels in three CHD groups were significantly higher than those in non-CHD controls(P<0.05),and there was not significantly different in the three CHD groups compared in pairs(above P>0.05);The level of LDL-C increased gradually with the aggravation of clinical types of coronary artery disease among the four groups.The difference in the level of LDL-C between NSTE-ACS group and STE-ACS group was not noted in statistics(P>0.05),but the difference between the other groups were noted in statistics(P<0.05).The level of HDL-C in CHD group was significantly lower than that in Non-CHD controls,and it was significantly higher in SAP group than that in STE-ACS group(P<0.05).The difference between SAP group and NSTE-ACS group in HDL-C was not noted in statistics(P>0.05),the same as between NSTE-ACS and STE-ACS group.2.The overall trend of FIB and NLR,in each group was:Non-CHD group<SAP group<NSTE-ACS group<STE-ACS group,whereas ALB was Non-CHD group>SAP group>NSTE-ACS group>STE-ACS group.The FAR increased with aggravation of clinical types.The above inflammatory biomarkers are compared among the four groups in pairs,FIB,FAR and NLR although in SAP group were higher than those in Non-CHD controls,ALB was lower,the difference between the two groups was not noted in statistics(P>0.05),the other CHD three group in the inner pairwise comparisons were statistically significant.The level of PLR in STE-ACS group were the highest comparised with the other three groups and the difference respectively were all noted in statistics(above P<0.05),but the difference between the three groups in pairs was not noted in statistics(above P>0.05).The hs-CRP of four groups in the inner pairwise comparisons were noted in statistics(P>0.05).It can be concluded FAR could reflect the degree of inflammatory state and stability of coronary heart disease to a certain extent.3.The trend of GS among the three CHD groups was:SAP group<NSTE-ACS group<STE-ACS group,but there was no statistical difference between the NSTE-AC group and the STE-ACS group.4.Association between variables was detected by Spearman’s correlation analyses between FAR and different inflammatory biomarkers.FAR was positively associated with hs-CRP(rs=0.822),NLR(rs=0.463),PLR(rs=0.296),FAR was significantly associated with hs-CRP.5.FIB,FAR,hs-CRP,NLR and PLR increased with the increase of the number of coronary artery lesions,whereas ALB decreased.Comparison with Single coronary artery lesion group,FIB、FAR and hs-CRP were significantly higher,whereas the difference of ALB was lower significantly in multiple coronary artery lesion group(double coronary artery and triple coronary artery lesion group)(above P<0.05).FIB、FAR、ALB、hs-CRP in multiple coronary artery lesion group were no significant differences(above P>0.05).Comparison with triple vascular lesion group,higher NLR and PLR were significantly different in single and double coronary artery lesion group(above P<0.05),whereas NLR、PLR were not between single and double coronary artery lesion group(P>0.05).GS were significantly different among the three groups,GS of triple coronary artery lesion group was the highest,the second was double coronary artery and in single coronary artery lesion group was minimum,The three groups in the inner pairwise comparisons were noted in statistics(above P<0.05).6.Independent sample T test showed that age,BMI were significantly different between the low GS group and the high GS group.Which were the same as the proportion of males,smokers,patients with hypertension and patients with diabetes mellitus detectde byχ~2test(P>0.05).The comparsion in TC,TG,ALT,CRE were also not noted in statistics(above P>0.05).Comparision with high GS group,higher LDL-C and lower HDL-C were noted in statistics.(above P<0.05).It can be seen that FAR and hs-CRP were better than NLR and PLR in evaluating the number of coronary artery lesions.7.In the high GS group,FIB,FAR,hs-CRP,NLR,PLR were significantly increased(P<0.05),while the ALB level was significantly reduced(P<0.001).8.When analyzing the correlation between each variabies and GS.FAR(rs=0.407),FIB(rs=0.325),hs-CRP(rs=0.394),NLR(rs=0.303),PLR(rs=0.170)were positively correlated with GS;while ALB wasnegatively correlated with GS(rs=-0.333).Obviously,the correlation between FAR and GS was the strongest.9.After binary Logistic regression analysis,FAR,hs-CRP levels were an independent predictor of high GS in patients with CHD(OR=1.274,95%CI:1.035 to 1.567,P=0.022;OR=1.757,95%CI:1.069 to 2.887,P=0.026 respectively).Therefore FAR is significantly related to GS in predicting the severity of coronary artery disease in patients with CHD.10.ROC curve was used to detect the predicted value of different inflammatory biomarkers for GS(≥20).The cut-off level of≥6.16 FAR predicted GS(≥20)[SN76.7%,SP 64.8%,area under curve(AUC)of 0.751,95%CI:0.698 to 0.804,P<0.001),the cut-off level of≥2.41 hs-CRP predicted GS(≥20)(SN 74.9%,SP 64.8%,AUC of0.729 95%CI:0.671 to 0.788,P<0.001).The cut-off level of≥8.66 FAR combined with hs-CRP predicted GS(≥20)(SN 72.8%,SP 68.5%,AUC of 0.761,95%CI:0.708 to0.815,P<0.001).The results revealed that the AUC of FAR was higher comparied with hs-CRP,and the AUC of FAR combined with hs-CRP was the highest in predicting high GS.11.Comparison with low FAR group,the incidence of triple vascular disease and STE-ACS were significantly higher in high FAR group,and the GS was higher similarly(above P<0.05).it suggests when the level of FAR more than 6.16 in those patients,triple coronary artery lesion and STE-ACS are more likely to occur,coronary artery disease is more serious,with the value of clinical application.Conclusion:1.The level of FAR,a novel inflammatory index,increased with the aggravation of clinical types of coronary heart disease,which might help assess the inflammatory load state and the stability of coronary artery lesions in patients with coronary heart disease.2.FAR is positively correlated with other established inflammatory indexes,FAR is correlation with coronary GS,closely related to the severity of coronary artery diseasein patients with coronary heart disease.3.FAR is an independent predictor for high GS,and the application of FAR and hs-CRP can improve the predictive value of high GS.4.FAR is helpful to evaluate the the number and severity of coronary artery lesions in patients with coronary heart disease.It has certain clinical application value. |
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