Relationship between fibrinogen -to- albumin ratio and angiographic no-reflow in elderly patients with st-elevation myocardial infarction treated with primary percutaneous coronary intervention

Abstract

Introduction: Primary percutaneous coronary intervention carries a low success rate and high procedural risk in elderly patients. No-reflow is a serious complication of primary percutaneous coronary intervention in the treatment of acute ST-elevation myocardial infarction. We evaluated whether admission fibrinogen-to-albumin ratio, which has emerged as an inflammatory and haemorheological marker for predicting adverse outcomes in some cardiovascular diseases, predicts angiographic no-reflow in elderly patients with ST-elevation myocardial infarction.Materials and Method: In total, 617 patients (78.1% men; median age, 75 (68-80years) who underwent primary percutaneous coronary intervention and were admitted within 12 hours from the onset of symptoms were classified into two groups based on the final thrombolysis in myocardial infarction flow grading. Noreflow was defined as post-percutaneous coronary intervention thrombolysis in myocardial infarction grade 0, 1 and 2, and angiographic success (normal reflow) was defined as thrombolysis in myocardial infarction grade 3.Results: Of the total, 29 (51.8%) patients were found to be frail, 22 (39.3%) were found to be prefrail, and 5 (8.9%) were found be nonfrail. Further, 34 (60.8%) patients were at the risk of malnutrition. Additionally, 38 (67.8%) patients had delirium and 8 (14%) patients died during the postoperative month 1. Although Nutritional Risk Screening 2002 scores positively correlated with first-month mortality, no correlation was found between malnutrition and delirium status. A positive correlation was found between clinical frailty scale score and delirium; however, there was no correlation between clinical frailty scale score and firstmonth mortality. Positive predictive values of malnutrition and frailty together for first-month mortality increased up to 54.5% from 17.6% and 13.6 and that of delirium increased to 80.2% from 54.5% and 72.4%, respectively.Conclusion: The incidence of angiographic no-reflow was 19.9% (n = 123). Patients with no-reflow had higher rates of diabetes and smoking, higher thrombus burden and Killip class≥2 on admission and lower baseline left ventricular ejection fraction; they also had increased white blood cell counts, C-reactive protein and fibrinogen-to-albumin ratio levels at admission than the normal flow group. In multivariate analysis, white blood cell count, smoking and fibrinogen-to-albumin ratio were independent predictors of angiographic no-reflow. ABSTRACTGiriş: Genç hastalarla karşılaştırıldığında, ileri yaş hastalarda primer perkütan koroner girişim, daha düşük başarı ve artmış prosedürel komplikasyonlarla ilişkilidir. No-reflow fenomeni, ST-yükselmeli miyokard enfarktüsü ile primer perkütan koroner girişim yapılan hastalarda karşılaşılabilecek en ciddi komplikasyonlardan biridir. Fibrinojen / albümin oranı; bazı kardiyovasküler hastalıklarda istenmeyen sonlanımları öngördüren, inflamasyon ve hemoreolojiyi yansıtan bir parametre olarak ortaya çıkmıştır. Biz bu çalışmada ST-yükselmeli miyokard enfarktüsü ile başv...

Fibrinogen–albumin ratio predicting major adverse cardiovascular outcomes post‐percutaneous coronary intervention: A systematic review and exploratory meta‐analysis

“…performed a study of 617 STEMI patients, who underwent PCI in older adults with median age of 75 years old and found that increased level of FAR was higher in the no‐reflow group compared to the normal flow group. 10 The no‐flow group was determined based on thrombolysis in myocardial infarction (TIMI) flow grades and TIMI < 3 in all these studies. 5 , 8 , 10 Until now, revascularization has been examined as a secondary endpoint with a very small pool of patients.…”

“… 10 The no‐flow group was determined based on thrombolysis in myocardial infarction (TIMI) flow grades and TIMI < 3 in all these studies. 5 , 8 , 10 Until now, revascularization has been examined as a secondary endpoint with a very small pool of patients. Overall, this meta‐analysis showed high FAR group may have a higher risk of requiring emergent‐unscheduled revascularization.…”