Relationship Between Fibrinogen To Albumin Ratio And No Reflow Of Coronary Artery In Patients With Acute ST-segment Elevation Myocardial Infarction

Background and objectiveCoronary artery disease(CAD)is coronary atherosclerotic disease,which can cause coronary artery stenosis and coronary heart disease.ST segment elevation myocardial infarction(STEMI)is the most acute type of coronary heart disease.Percutaneous coronary intervention(PCI)has become the first choice of reperfusion strategy for STEMI patients.Early diagnosis and immediate reperfusion are the most effective methods to limit the area of myocardial ischemia and infarction,so as to reduce heart failure and other complications in STEMI patients.However,after PCI successfully opened the occlusion vessels,there were still some patients with myocardial perfusion insufficiency,and no reflow may occur.There is no literature reported that the incidence rate of PCI in the emergency myocardial infarction is 15%-30%.It was found that oxidative stress,inflammatory response,endothelial function and microembolism were related to no reflow of coronary artery.There are many reasons that may lead to no reflow during PCI,which is a serious complication of PCI,especially for STEMI patients,which can increase their long-term mortality.Screening out the high-risk group of no reflow before operation,timely intervention,can reduce the incidence of no reflow and significantly improve the prognosis of patients.Fibrinogen can promote platelet aggregation,increase blood viscosity and peripheral resistance,cause endothelial cell damage,chemotactic mononuclear and macrophage migration to the subintima,and promote red blood cell deposition and thrombosis.Albumin can affect all aspects of microvascular integrity and inflammatory pathways,including neutrophil adhesion and cell signaling activity.Therefore,we speculate that they are involved in the occurrence of no reflow.There is no study on the relationship between far and no reflow of coronary artery.The purpose of this study is to investigate the relationship between far and no reflow during PCI.Materials and methodsFrom June 2015 to January 2019,the patients who underwent PCI due to STEMI in our hospital were selected for retrospective analysis.There were 50 patients with no reflow phenomenon(TIMI 0?2 grade)during the operation,and 168 patients with intraoperative reflow(TIMI 3 grade)during the same period were selected as the control.Before operation,they were given loading doses of aspirin enteric coated tablets 300mg and tegrilol 180mg.The clinical baseline data,laboratory indexes,color Doppler ultrasonography and coronary angiography between the two groups were recorded and compared.According to the cutoff value of ROC curve,the patients were divided into high far group and low far group.The incidence of no reflow of coronary artery and the incidence of major adverse cardiovascular and cerebrovascular events(MACCE)were compared between the two groups.Pearson correlation analysis was used to analyze the correlation between far and hs CRP,albumin,fibrinogen,LVEF,multivariate logistic regression analysis of influencing factors of no reflow of coronary artery,and ROC curve method was used to analyze the value of far in predicting coronary artery no reflow.Results1.There is no significant difference between the two groups in age,gender,hypertension,diabetes,smoking and preoperative administration of ACEI/ARB,calcium antagonists,beta blockers,statins,aspirin and clopidogrel(P>0.05).The LVEF of no reflow group was lower than that of control group,the difference was statistically significant(P<0.05).There is no significant difference in blood glucose,hemoglobin,TG,TC,LDL-C,HDL-C,total bilirubin,alt,AST,GGT,leukocyte count,lymphocyte count and platelet count between the two groups(P>0.05).The concentration of albumin in the control group was higher than that in the no reflow group,while the levels of fibrinogen,hs-CRP and far were lower than that in the no reflow group,the difference was statistically significant(P<0.05).There is no significant difference between the two groups in the time from chest pain to interventional therapy,the location of infarct related vessels and myocardial infarction(P>0.05).2.According to the cutoff value of ROC curve,the patients were divided into high far group(FAR?10.82)and low far group(FAR<10.82).The incidence of no reflow of coronary artery in high far group was significantly higher than that in low far group,and the difference is statistically significant(P<0.001).The incidence of MACCE events in high far group was higher than that in low far group after 6 months follow-up,the difference is statistically significant(P<0.001).3.Pearson correlation analysis showed that FAR is positively correlated with hs CRP,but not with albumin,fibrinogen and LVEF.4.Variable fibrinogen,albumin,FAR,hs CRP and LVEF with statistical significance in univariate analysis are included in logistic regression analysis,The results showed that FAR,fibrinogen and albumin are all independent factors of coronary artery no reflow in STEMI patients(P<0.05).There is a positive correlation between the concentration of far and fibrinogen and no reflow,and a negative correlation between the concentration of albumin and no reflow.5.The ROC curve showed that the area under the curve predicted by FAR IS 0.750,the critical value IS 10.82,the sensitivity of the critical value IS 83.3%,and the specificity IS 64.0%,It has predictive value(95%CI:0.660?0.840,P<0.001).Conclusion1.FAR is independently associated with no reflow of coronary artery after PCI in patients with acute STEMI,The higher the level of FAR,the higher the incidence of no reflow.2.FAR is related to the prognosis of acute STEMI patients after PCI and can be used to evaluate the prognosis.