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Abstract：
BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic unmasked the huge deficit in healthcare resources worldwide. It highlighted the need for efficient risk stratification in management of cardiovascular emergencies.
OBJECTIVE: To study the applicability of the old, available and affordable nonconventional biomarkers: albumin and fibrinogen in their ability to predict angiographic severity and clinical outcomes in patients with acute coronary syndrome (ACS).
METHODS: In this prospective, observational study, 166 consecutive patients with ACS were enrolled. Fibrinogen, albumin and their ratio were determined from serum. Patients with underlying chronic liver disease, active malignancy, autoimmune disease, active COVID-19 infection and undergoing thrombolysis were excluded.
RESULTS: Mean age of the population was 60.5 ± 1.5 years, 74.1% being males. ST elevation myocardial infarction (STEMI) was most common presentation of ACS seen in 57% patients. Fibrinogen albumin ratio (FAR) ≥ 19.2, had a sensitivity of 76.9% and specificity of 78.9 % [area under the receiver operating characteristic curves (AUROC) = 0.8, P = 0.001] to predict ≤ thrombolysis in myocardial infarction (TIMI) 1 flow in culprit artery in STEMI patients. Even in non-STEMI patients, FAR ≥ 18.85 predicted the same with 80% sensitivity and 63% specificity (AUROC = 0.715, P = 0.006).
CONCLUSIONS: Novel biomarkers, with their high cost, lack of availability and long turn over time are impractical for real-world use. Identifying ≤ TIMI 1 flow in the culprit artery has significant impact of management and outcome. Our study has shown that readily available biomarkers like fibrinogen and albumin can help identify these high-risk patients with good accuracy. This allows risk-stratification and individualization of treatment in ACS.
OBJECTIVE: To study the applicability of the old, available and affordable nonconventional biomarkers: albumin and fibrinogen in their ability to predict angiographic severity and clinical outcomes in patients with acute coronary syndrome (ACS).
METHODS: In this prospective, observational study, 166 consecutive patients with ACS were enrolled. Fibrinogen, albumin and their ratio were determined from serum. Patients with underlying chronic liver disease, active malignancy, autoimmune disease, active COVID-19 infection and undergoing thrombolysis were excluded.
RESULTS: Mean age of the population was 60.5 ± 1.5 years, 74.1% being males. ST elevation myocardial infarction (STEMI) was most common presentation of ACS seen in 57% patients. Fibrinogen albumin ratio (FAR) ≥ 19.2, had a sensitivity of 76.9% and specificity of 78.9 % [area under the receiver operating characteristic curves (AUROC) = 0.8, P = 0.001] to predict ≤ thrombolysis in myocardial infarction (TIMI) 1 flow in culprit artery in STEMI patients. Even in non-STEMI patients, FAR ≥ 18.85 predicted the same with 80% sensitivity and 63% specificity (AUROC = 0.715, P = 0.006).
CONCLUSIONS: Novel biomarkers, with their high cost, lack of availability and long turn over time are impractical for real-world use. Identifying ≤ TIMI 1 flow in the culprit artery has significant impact of management and outcome. Our study has shown that readily available biomarkers like fibrinogen and albumin can help identify these high-risk patients with good accuracy. This allows risk-stratification and individualization of treatment in ACS.
摘要：
背景：2019年冠状病毒病(COVID-19)大流行揭露了全球医疗保健资源的巨大短缺。它强调了在心血管紧急情况管理中需要有效的风险分层。
目的：为了研究老年人的适用性，可用且负担得起的非常规生物标志物:白蛋白和纤维蛋白原预测急性冠脉综合征(ACS)患者血管造影严重程度和临床结局的能力.
方法：在此前瞻性中，观察性研究，纳入166例连续ACS患者。纤维蛋白原,从血清中测定白蛋白及其比值。慢性肝病患者，活动性恶性肿瘤，自身免疫性疾病，排除活动性COVID-19感染和接受溶栓治疗的患者.
结果：人口的平均年龄为60.5±1.5岁，74.1%是男性。在57％的患者中，ST段抬高型心肌梗死（STEMI）是最常见的ACS表现。纤维蛋白原白蛋白比值(FAR)≥19.2,预测STEMI患者罪犯动脉≤溶栓的敏感性为76.9%,特异性为78.9%[受试者工作特征曲线下面积(AUROC)=0.8,P=0.001]。即使在非STEMI患者中，FAR≥18.85预测相同，敏感性为80％，特异性为63％（AUROC=0.715，P=0.006）。
结论：新型生物标志物，他们的高成本，缺乏可用性和长时间周转对于现实世界的使用是不切实际的。确定罪犯动脉中的≤TIMI1流量对管理和结果有重大影响。我们的研究表明，容易获得的生物标志物如纤维蛋白原和白蛋白可以帮助识别这些高风险患者具有良好的准确性。这允许在ACS中进行风险分层和个体化治疗。
目的：为了研究老年人的适用性，可用且负担得起的非常规生物标志物:白蛋白和纤维蛋白原预测急性冠脉综合征(ACS)患者血管造影严重程度和临床结局的能力.
方法：在此前瞻性中，观察性研究，纳入166例连续ACS患者。纤维蛋白原,从血清中测定白蛋白及其比值。慢性肝病患者，活动性恶性肿瘤，自身免疫性疾病，排除活动性COVID-19感染和接受溶栓治疗的患者.
结果：人口的平均年龄为60.5±1.5岁，74.1%是男性。在57％的患者中，ST段抬高型心肌梗死（STEMI）是最常见的ACS表现。纤维蛋白原白蛋白比值(FAR)≥19.2,预测STEMI患者罪犯动脉≤溶栓的敏感性为76.9%,特异性为78.9%[受试者工作特征曲线下面积(AUROC)=0.8,P=0.001]。即使在非STEMI患者中，FAR≥18.85预测相同，敏感性为80％，特异性为63％（AUROC=0.715，P=0.006）。
结论：新型生物标志物，他们的高成本，缺乏可用性和长时间周转对于现实世界的使用是不切实际的。确定罪犯动脉中的≤TIMI1流量对管理和结果有重大影响。我们的研究表明，容易获得的生物标志物如纤维蛋白原和白蛋白可以帮助识别这些高风险患者具有良好的准确性。这允许在ACS中进行风险分层和个体化治疗。
