China: Liver Fibrosis and Cardiovascular Risk in ACS Patients

Liver fibrosis staged by the Fibrosis-4 (FIB-4) index corresponds to an increased risk of myocardial infarction, MACCE, and mortality in acute coronary syndrome (ACS) patients who underwent PCI independent of diabetes status, a recent study has shown. However, it was not associated with stroke and bleeding events.

The findings, published in Diabetes Research and Clinical Practice, suggest that FIB-4 may be helpful in risk stratification of ACS patients independent of the presence or absence of diabetes.

Jingjing Song and a research team from China and colleagues conducted the study to examine the effect of liver fibrosis, assessed by the Fibrosis-4 index, on cardiovascular events in patients with the acute coronary syndrome with and without type 2 diabetes mellitus (T2DM).

For this purpose, the researchers analyzed 6563 ACS patients undergoing PCI. The participants were divided into three groups based on the literature-based FIB-4 cut-offs: < 1.45, 1.45-3.25, and ≥3.25.

Key Findings

• During the median 2.4-year follow-up, 270 major adverse cardiac and cerebrovascular events and 194 major bleeding were recorded.
• Intermediate or high FIB-4 scores were significantly associated with an elevated risk of MACCE, mortality, and myocardial infarction but not related to ischemic stroke and major bleeding.
• Further restricted cubic spline analysis showed that FIB-4 as a continuous variable was positively associated with increased adjusted risk of MACCE.
• The results were consistent in subgroups with and without type 2 diabetes.

Liver fibrosis assessed by the FIB-4 index was shown to be linked with myocardial infarction, mortality, and MACCE but not bleeding events and stroke in acute coronary syndrome patients, regardless of type 2 diabetes status.

"The FIB-4 index is useful to improve risk stratification for ischemic cardiac events in ACS patients," the authors wrote. "The study prompted liver fibrosis screening with non-invasive indices in ACS patients with or without type 2 diabetes to identify high-risk patients and help decision-making in clinical practice."

Reference

The study titled "Fibrosis-4 stage of liver fibrosis predicts cardiovascular outcomes in acute coronary syndrome patients with and without type 2 diabetes mellitus" was published in Diabetes Research and Clinical Practice. DOI: https://doi.org/10.1016/j.diabres.2022.110206