纤维蛋白原/白蛋白比值预测急性ST段抬高型心肌梗死患者长期预后的临床研究

Role of Fibrinogen-to-Albumin Ratio in Predicting Long-Term Prognosis in Patients with Acute ST-Segment Elevation Myocardial Infarction

目的探讨纤维蛋白原/白蛋白比值(fibrinogen-to-albumin ratio,FAR)对急性ST段抬高型心肌梗死(STsegment elevation myocardial infarction,STEMI)患者长期预后的预测价值。方法连续纳入2011年7月至2019年4月于南京市第一医院诊断为STEMI并行急诊冠状动脉(冠脉)介入治疗的患者,收集患者一般临床资料、实验室检查结果、冠状动脉造影及药物治疗数据,主要观察终点为全因死亡。结果总计纳入1124例STEMI患者,随访时间为(75±32)个月,124例患者出现全因死亡。受试者工作特征曲线(receiver operating characteristic curve,ROC)分析显示FAR可以预测STEMI患者全因死亡,曲线下面积为0.637,其中以81.1作为界值时,敏感度为54.8%,特异度为68.8%。高FAR患者年龄、糖尿病比例、KillipⅢ~Ⅳ级比例、胸痛至就诊时间、主动脉内球囊反搏(intra-aortic balloon pump,IABP)植入、住院时间及院内死亡明显升高,而平均动脉压、左心室射血分数、单支病变及替格瑞洛使用比例明显降低。Kaplan-Meier曲线显示,高FAR组患者全因死亡显著高于低FAR组(log-lank P<0.001)。多因素COX分析显示,年龄、Killip分级、肌酐、高FAR、左心室射血分数、单支病变、IABP植入、替格瑞洛及β受体阻断药为STMEI患者全因死亡的独立预测因素。结论FAR作为一种新型的生物标志物,可以预测STEMI患者全因死亡。

Objectives To explore the predictive value of the fibrinogen-to-albumin ratio(FAR)in the long-term prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI).Methods Patients diagnosed with STEMI in Nanjing First Hospital from July 2011 to April 2019 were continuously enrolled.Emergent percutaneous coronary intervention(PCI)was performed in all the patients.The study collected general clinical data,laboratory results,coronary angiography and drug therapy data.The primary endpoint was all-cause mortality.Results A total of 1124 STEMI patients were included with a mean follow-up of(75±32)months.All-cause mortality occured in 124 patients.Receiver operating characteristic curve(ROC)analysis showed that FAR could predict all-cause mortality in STEMI patients,and the area under the curve was 0.637.When 81.1 was used as the cut-off value,the sensitivity was 54.8%,and the specificity was 68.8%.Patients with high FAR tended to be older,had a higher proportion of diabetes mellitus,a higher Killip grade,longer duration from chest pain to the hospital,more patients with intra-aortic balloon pump(IABP)implantation,longer hospital stays,and higher in-hospital death rates.Meanwhile,patients with high FAR had lower mean arterial pressure,lower left ventricular ejection fraction,more cases of single vessel disease and lower use of ticagrelor.Kaplan-Meier curve showed that all-cause mortality were significantly higher in high FAR group than in low FAR group(log-lank P<0.001).Multivariate COX regression analysis identified that age,Killip grade,creatinine,high FAR,left ventricular ejection fraction,single-vessel disease,IABP implantation,ticagrelor and beta-blockers Intrawere independent predictors of all-cause mortality in STMEI patients.Conclusions FAR is a promising biomarker for predicting all-cause mortality in STEMI patients.