The association between fibrinogen-to-albumin ratio and adverse prognosis in patients with myocardial infarction with non-obstructive coronary arteries

Background: The fibrinogen-to-albumin ratio (FAR) has been identified as a new inflammatory marker for predicting the risk of cardiovascular diseases. Nevertheless, its prognostic relevance in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) remains uncertain. Methods: This study included a total of 1031 hospitalized patients diagnosed with MINOCA, enrolled consecutively. The primary outcome was the occurrence of major adverse cardiovascular events (MACE). Based on the median FAR value, patients were divided into high FAR (FAR-H) and low FAR (FAR-L) groups. Baseline clinical characteristics and the incidence of adverse events during the follow-up period were compared between the two groups. Various statistical methods were applied, including restricted cubic spline modeling, Kaplan-Meier survival analysis, and Cox proportional hazards modeling. Results: The median follow-up duration was 42.3 months, during which 157 patients (15.2 %) experienced MACE. The FAR-H group had a significantly higher incidence of MACE compared to the FAR-L group (21.2 % vs. 9.3 %, p < 0.001). Multivariate Cox regression analysis revealed that a higher FAR was an independent predictor of long-term MACE in MINOCA patients (hazard ratio = 2.76, 95 % confidence interval: 1.95-3.89, p < 0.001), after adjusting for relevant clinical variables. Conclusions: An elevated FAR is linked to a poor long-term prognosis in patients with MINOCA.