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

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. No-reflow 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 first-month 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.