Correlation Analysis Of Fibrinogen To Albumin Ratio And The Collateral Circulation Formation And Gensini Score Of Coronary Chronic Total Occlusion

Objective: We analyzed the clinical characteristics of coronary chronic total occlusion(CTO)to clarify the relationship between fibrinogen to albumin ratio(FAR)and the severity of coronary CTO,which was assessed from coronary collateral circulation(CCC)formation and Gensini score,providing certain reference value for the early detection and diagnosis of severe coronary CTO lesions.Methods: The clinical characteristics of 196 patients with coronary CTO admitted to the Department of Cardiology,The Affiliated Yantai Yuhuangding Hospital of Qingdao University from January 2020 to June 2022 were retrospectively analyzed.According to the results of angiography and Rentrop classification standard,patients with Rentrop grade 2-3 were divided into good-CCC group(101 cases)and those with grade 0-1 into poor-CCC group(95 cases).According to the Gensini score standard,patients with score more than 60(the median)were divided into high score group(65 cases)and those with0-60 score were divided into low score group(131 cases).Spearman correlation analysis was used to explore the relationship between Gensini score and other clinical indicators.In univariate analysis,normally distributed data was analyzed by independent-sample Ttest and rank sum test was operated for skewed data processing.Univariate and multivariate logistic regression analysis showed the risk factors related to the poor-CCC formation and high Gensini score in coronary CTO patients,and ROC curves were used to analyze the predictive power of risk factors.Follow-up data were collected to calculate the survival rate of major adverse cardiovascular events(MACE)endpoints.We further analyzed the survival curves by Kaplan-Meier method.Log-rank method and Cox proportional hazards model were adopted to discuss the prognosis of involved factors.Results:1.A total of 196 patients with coronary chronic total occlusion confirmed by coronary angiography results were enrolled in the study,including 136 males and 60 females;98 cases aged ≤ 62.5 years,98 cases > 62.5 years old;87 cases with a history of diabetes and 109 cases with no history of diabetes;43 cases with a family history of cardiovascular disease and 153 cases with no family history of cardiovascular disease;72 cases with a history of smoking and 124 cases with no history of smoking;37 cases with a history of alcohol consumption and 159 cases with no history of alcohol consumption;95 cases with poor-CCC and 101 cases with good-CCC;65 cases with high Gensini score and 131 cases with low Gensini score.2.There were statistically significant differences in fibrinogen(FIB)(P<0.001),FAR(P<0.001),SUA(P<0.001),blood total cholesterol(TC)(P=0.031)and body mass index(BMI)(P=0.049)between the poor-CCC group and the good-CCC group(all P<0.05).There were statistically significant differences in FIB(P<0.001),FAR(P<0.001),SUA(P=0.020)and CCC formation(P<0.001)between low Gensini score group and high Gensini score group(all P<0.05).3.Spearman correlation analysis revealed that FIB(P<0.001),FAR(P<0.001)and SUA(P<0.001)were positively related to Gensini score in patients with coronary CTO.The ALB level(P<0.001)showed a negative correlation with Gensini score in coronary CTO patients.4.Univariate and multivariate logistic regression analysis showed that FAR,SUA and TC were risk factors for poor CCC formation in coronary CTO.FAR was an independent risk factor for high Gensini score in coronary CTO patients.5.The areas under the ROC curves(AUC)of TC level,SUA level and FAR level for predicting poor-CCC were 0.589,0.661 and 0.738,respectively,and the optimal diagnostic cut-off values were 0.031mmol/L,331.5μmol/L and 0.07355,respectively.Further analysis and comparison showed that FAR was a better indicator for predicting poor CCC formation with a sensitivity of 81.1% and a specificity of 67.3%.The AUC of FAR level predicting high Gensini score was 0.871.The optimal diagnostic cut-off value of FAR was 0.07535,with a sensitivity of 86.2% and a specificity of 82.4%,suggesting that FAR can be recognized as an excellent predictor for predicting high Gensini score in patients with coronary CTO.6.Poor-CCC(P=0.007),high Gensini score(P<0.001),failed revascularization(P=0.001),FAR≥0.07355(P<0.001),FAR≥0.07535(P<0.001),and SUA≥329.5μmol/L(P=0.005)were found to be closely related to MACE in coronary CTO patients through Kaplan-Meier analysis.Multivariate prognostic analysis by Cox proportional hazards model showed that high Gensini score(HR=4.236,95%CI: 1.456-12.326,P=0.008)was an independent predictor of MACE in coronary CTO patients.Conclusion:1.FAR has a good predictive value for poor collateral circulation formation in patients with coronary CTO.2.FAR is strongly positively correlated with Gensini score in patients with coronary CTO and is a powerful predictor of high Gensini score(score>60)in patients with coronary CTO.3.FAR is associated with a high incidence of MACE in patients with coronary CTO.