Background: ACS is a medical emergency, which is characterized by significant short and long term adverse outcomes. COVID-19 pandemic has overwhelmed our healthcare resources, thus to efficiently manage cardiovascular emergencies risk stratification is a necessity. We carried out a prospective observational study, to analyze role of old, nonconventional biomarkers in their ability to predict angiographic severity and clinical outcomes in patients.
Method and Results: Hundred and sixty six patients of ACS, were consecutively enrolled into the study. Inflammatory biomarkers; fibrinogen, albumin and their ratio (FAR) were determined from serum. Thyroid function tests and cortisol was also analyzed using immunoassay. Angiographic assessment was done by two interventional cardiologists .Exclusion criteria included patients who had undergone thrombolysis, history of chronic liver disease, active malignancy, autoimmune disease. Patients with known thyroid disorder and history of steroid intake were also excluded from study. Mean age of our population was 60.5 ± 1.5 years, with two third of the cohort comprising of males. Among risk factors of CAD, hypertension and DM were most common present in over half the patients. STEMI was most common presentation of ACS seen in 57% patients. Among patients of ACS 15.6% had cardiogenic shock and 19.8 % had Killip class ≥2 at presentation Culprit artery total occlusion was present in 32% (54/152) patients which was significantly higher in STEMI (41%) compared to NSTEACS (21%), P=0.019. Fibrinogen using a cutoff value of 6.5 , a sensitivity of 74% and specificity of 74% (AUROC =0.8 , P= 0.001) was reached to predict ≤ TIMI 1 flow in culprit artery in patients with STEMI while with cutoff value of 6.15 it was able to do so even in patients with NSTEACS with reasonable accuracy. FAR with cut off value 18.85, had sensitivity of 73% and specificity of 57.6% (AUROC= 0.71, P=. 0.006) to predict total occlusion among patients with NSTEACS, while its cut off value was 19.2 among patients with STEMI with a good accuracy. Albumin was found to be significantly lower among non survivors at 30 days compared to survivors. Low T3 syndrome being most common endocrinological disorder was present in 27% patients with these patients having increased relative risk of 4.2 ; CI: 2.2 -7.9 and 6.8 , CI 2.3 -19.7 to have significant ischemic MR and CS at presentation. Increased cortisol was also associated with increased risk of heart failure at presentation.
Conclusion: Novel biomarkers, with their high cost and lack of availability and long turn over time are impractical for real world use. Our study has shown that readily available biomarkers like fibrinogen and albumin allows an efficient way to identify high risk patients. These biomarkers would be beneficial in risk stratification and management of ACS to allow individualization of treatment during ongoing pandemic.
ABCSI21056