JMIR Publications

ABSTRACT

Background:

Identification of risk factors is essential in patients with coronary artery disease (CAD). As an important inflammatory factor and a key participant in coagulation, fibrinogen has attracted attention in the management of acute coronary syndrome (ACS). However, the relationship between the fibrinogen level and the prognosis of patients with ACS remains controversial.1 Our previous study found that fibrinogen was an independent risk factor for mortality during the follow-up in patients with CAD (adjusted HR: 1.40 (1.16–1.68)).2 In the ACS subgroup, no correlation was found between the fibrinogen level and mortality. In addition, the quantitative relationship between fibrinogen and the risk of mortality in a longer follow-up period needs further clarification.

Objective:

To Identify the Relationship Between Fibrinogen Level and the 10-year Mortality in Patients with Acute Coronary Syndrome

Methods:

We performed a prospective, large-scale, single-centre registry (ChiCTR2100049313) study to investigate the effect of fibrinogen on ACS prognoses. Patients were grouped by the five quantile levels of the plasma fibrinogen at admission. We used the Kaplan-Meier analysis to estimate the cumulative incidence of all-cause mortality. The predictive value of the fibrinogen level for the 10-year mortality was estimated by a Cox proportional hazards regression model. The impact of the fibrinogen on the 10-year mortality was assessed by a restricted cubic spline (RCS) curve, which was derived from an adjusted Cox proportional hazards regression model.

Results:

The RCS curve suggested strong U-shaped relationships between the adjusted risk of the 10-year mortality and the fibrinogen level, which was in accordance with the trend found in the Kaplan-Meier analysis. The risk of all-cause mortality decreased until the fibrinogen reached 2.81 g/L, and it then started to increase afterwards (P for nonlinearity < 0.0001).

Conclusions:

Kaplan-Meier curves (A) show a cumulative incidence of all-cause mortality at 10 years after it was stratified by five quantiles of the plasma fibrinogen level at admission. The restricted cubic-spline curve (B) shows the adjusted hazard ratio and its 95% confidence interval for the 10-year all-cause mortality based on the plasma fibrinogen level. The p-value for nonlinearity was < 0.001.