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      The Fibrinogen-to-Albumin Ratio Is Associated With Outcomes in Patients With Coronary Artery Disease Who Underwent Percutaneous Coronary Intervention

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          Abstract

          Coronary artery disease (CAD) is a systemic chronic inflammatory disease, and serum fibrinogen and albumin are 2 important factors in systemic inflammation. We aimed to investigate the relationship between the fibrinogen–albumin ratio (FAR) and outcomes in patients with CAD who underwent percutaneous coronary intervention (PCI). All patients were from the Clinical Outcomes and Risk Factors of Patients with Coronary Heart Disease after PCI (CORFCHD-PCI) study, which is a retrospective cohort study (Identifier: ChiCTR-ORC-16010153) that includes a total of 6050 patients with CAD after PCI from January 2008 to December 2016. A total of 5829 patients with CAD after PCI were recruited in the present study. They were divided into 2 groups according to the FAR cutoff value, which was calculated using a receiver operating characteristic curve, a low group (FAR < 0.095, n = 3811), and a high group (FAR ≥ 0.095, n = 2018). The average follow-up time was 35.9 ± 22.6 months. The multivariate Cox proportional hazards model showed that FAR was independently correlated with all-cause mortality (adjusted hazard ratio [HR] = 1.432 [1.134-1.808], P = .003), cardiac mortality (adjusted HR = 1.579 [1.218-2.047], P = .001), major adverse cardiac and cerebrovascular events (adjusted HR = 1.296 [1.125-1.494], P < .001), major adverse cardiac events (adjusted HR = 1.357 [1.170-1.572], P < .001), and heart failure (adjusted HR = 1.540 [1.135-2.091], P = .006). The present study indicated that the FAR was associated with adverse outcomes in patients with CAD who underwent PCI.

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          Inflammation and its resolution as determinants of acute coronary syndromes.

          Inflammation contributes to many of the characteristics of plaques implicated in the pathogenesis of acute coronary syndromes. Moreover, inflammatory pathways not only regulate the properties of plaques that precipitate acute coronary syndromes but also modulate the clinical consequences of the thrombotic complications of atherosclerosis. This synthesis will provide an update on the fundamental mechanisms of inflammatory responses that govern acute coronary syndromes and also highlight the ongoing balance between proinflammatory mechanisms and endogenous pathways that can promote the resolution of inflammation. An appreciation of the countervailing mechanisms that modulate inflammation in relation to acute coronary syndromes enriches our fundamental understanding of the pathophysiology of this important manifestation of atherosclerosis. In addition, these insights provide glimpses into potential novel therapeutic interventions to forestall this ultimate complication of the disease. © 2014 American Heart Association, Inc.
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            Inhibition of albumin synthesis in chronic diseases: molecular mechanisms.

            The albumin gene is expressed specifically in the liver after birth, and this expression is regulated predominantly at the transcriptional level. Regulatory proteins occupy specific DNA sequences within the promoter and enhancer of the albumin gene. The interaction between the CCAAT/enhancer binding protein (C/EBP)-beta and the albumin DNA is critical for albumin synthesis. Cachexia-induced hypoalbuminemia is mediated by tumor necrosis factor (TNF)-alpha. In turn, TNF-alpha stimulates oxidative stress, NO synthesis, and phosphorylation of C/EBP-beta within its nuclear localization signal (NLS). Consequently, C/EBP-beta is exported from the nucleus, preventing it to act as a transcriptional factor on the albumin gene. Antioxidants, NOS inhibitors. and dominant negative, nonphosphorylatable C/EBP-beta peptides block phosphorylation of C/EBP-beta within the NLS and its nuclear export as well as rescue the abnormal albumin gene expression, suggesting potential therapeutic interventions.
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              Decreased admission serum albumin level is an independent predictor of long-term mortality in hospital survivors of acute myocardial infarction. Soroka Acute Myocardial Infarction II (SAMI-II) project.

              Decreased serum albumin level (SAL) was reported to be associated with increased risk of cardiovascular events and short term-mortality in patients with acute myocardial infarction (AMI).
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                Author and article information

                Journal
                Clin Appl Thromb Hemost
                Clin. Appl. Thromb. Hemost
                CAT
                spcat
                Clinical and Applied Thrombosis/Hemostasis
                SAGE Publications (Sage CA: Los Angeles, CA )
                1076-0296
                1938-2723
                29 June 2020
                Jan-Dec 2020
                : 26
                : 1076029620933008
                Affiliations
                [1 ]Heart Center & Beijing Key Laboratory of Hypertension Disease, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
                [2 ]Department of Science and Technology, Xinjiang Medical University, Urumqi, China
                [3 ]Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
                [4 ]Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
                [5 ]Key Laboratory of Cardiac Injury and Repair of Henan Province, Zhengzhou, China
                Author notes
                [*]Ying-Ying Zheng, Department of Cardiology, First Affiliated Hospital of Zhengzhou University, No. 1, Jianshe Road, Zhengzhou, Henan, China. Email: zhengying527@ 123456163.com
                Article
                10.1177_1076029620933008
                10.1177/1076029620933008
                7427009
                32598182
                ca6119d8-9297-4d71-9174-6a93603ccb44
                © The Author(s) 2020

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

                History
                : 04 February 2020
                : 06 May 2020
                : 18 May 2020
                Categories
                Original Article
                Custom metadata
                January-December 2020
                ts3

                fibrinogen to albumin ratio,mortality,major adverse cardiac and cerebrovascular events,major adverse cardiac events,coronary artery disease,percutaneous coronary intervention

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