FAGR Outperforms Fibrinogen in Predicting Mortality in STEMI Patients: Study Finds

The findings, published in Scientific Reports, indicate that FAGR proved to be a significant predictor of all-cause and cardiovascular mortality in patients with acute STEMI undergoing emergency PCI. A higher FAGR was associated with increased mortality rates, outperforming fibrinogen in prognostic accuracy (ROC curve of 0.720 for all-cause mortality and 0.726 for cardiovascular mortality), highlighting its potential as a valuable prognostic marker in STEMI patients.

STEMI is a life-threatening condition that requires immediate medical intervention to restore blood flow to the heart. Despite advancements in PCI, patient outcomes vary significantly, necessitating the identification of reliable prognostic indicators. The researchers note that while the fibrinogen-to-albumin-to-globulin ratio has been recognized for its association with coronary artery disease (CAD), its role in acute STEMI remains insufficiently explored. To bridge this gap, Lixing Chen, Department of Cardiology, Kunming Medical University First Affiliated Hospital, Kunming, Yunnan Province, China, and colleagues aimed to assess the prognostic potential of FAGR in STEMI patients.

For this purpose, the researchers enrolled 1,042 STEMI patients who underwent emergency PCI at the First Affiliated Hospital of Kunming Medical University between June 2018 and January 2023. Based on the median FAGR (2.44), patients were categorized into low and high FAGR groups. The predictive value of FAGR for all-cause and cardiovascular mortality was assessed using Kaplan–Meier plots, restricted cubic spline regression, Cox survival analyses, and time-dependent ROC analyses.

The key findings of the study were as follows:

• Kaplan–Meier analysis showed a higher cumulative incidence of all-cause and cardiovascular mortality in the high FAGR group.
• Multivariate Cox proportional hazard analysis identified FAGR as an independent predictor of all-cause and cardiovascular death.
• For all-cause mortality, FAGR demonstrated a stronger predictive value (AUC = 0.720) compared to fibrinogen (AUC = 0.687).
• FAGR outperformed fibrinogen for cardiovascular mortality in prediction accuracy (AUC = 0.726 vs. 0.698).

The findings suggest that FAGR is a valuable prognostic indicator in STEMI patients undergoing emergency PCI. According to the authors, the study, the first to report its prognostic significance in STEMI, demonstrated that patients with a higher FAGR had greater all-cause and cardiovascular mortality than those with a lower FAGR. Moreover, FAGR emerged as an independent predictor of mortality, showing superior predictive accuracy compared to fibrinogen.

"However, as a single-center retrospective study, it has limitations, including potential data bias despite adjustments for confounding factors. Further prospective research is needed to validate these findings and establish FAGR's role in clinical practice," the authors concluded.

Reference:

Yang, S., Zhou, Y., Xu, D., Dong, Y., Tang, H., Jing, P., Lu, Y., Yuan, M., Zhao, Z., & Chen, L. (2025). The associations between the FAGR and all-cause and cardiovascular mortality in patients with STEMI. Scientific Reports, 15(1), 1-9. https://doi.org/10.1038/s41598-025-93951-0