Circulation reports · 2026
Profiles and Prognostic Value of a Non-Invasive Liver Fibrosis Marker in Patients With Acute and Chronic Coronary Syndrome: Insights From the CLIDAS-PCI.
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Saitoh Wataru, Shimada Takenobu, Fukuda Daiju, Shibata Atsushi, Ito Asahiro, Otsuka Kenichiro, Okamura Hiroshi, Matoba Tetsuya, Kohro Takahide, Oba Yusuke, Makimoto Hisaki, Kabutoya Tomoyuki, Imai Yasushi, Kario Kazuomi, Kiyosue Arihiro, Kodera Satoshi, Mizuno Yoshiko, Nochioka Kotaro, Nakayama Masaharu, Iwai Takamasa, Miyamoto Yoshihiro, Ishii Masanobu, Nakamura Taishi, Tsujita Kenichi, Sato Hisahiko, Akashi Naoyuki, Fujita Hideo, Nagai Ryozo, CLIDAS Research Group
Аннотация
BACKGROUND: The Fibrosis-4 (Fib-4) index, a non-invasive liver fibrosis marker, is useful for assessing cardiovascular risk; however, its role and profiles in patients with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS) remain unclear.
METHODS AND RESULTS: We analyzed 5,150 patients (ACS: 2,274; CCS: 2,876) from the Clinical Deep Data Accumulation System-Percutaneous Coronary Intervention (CLIDAS-PCI) database. The Fib-4 index was calculated 1-3 months post-PCI to avoid acute-phase transaminase elevation. Patients were stratified into low (<1.3), intermediate (1.3-2.67), and high (>2.67) Fib-4 categories. Longitudinal changes were assessed every 6 months for 2 years. The primary outcome was 3-point major adverse cardiovascular events (3P-MACE): cardiovascular death, non-fatal myocardial infarction, and stroke. Compared with CCS, ACS patients had fewer comorbidities and more intensive medical therapy. The Fib-4 index was lower in ACS than in CCS (1.83 vs. 1.93; P<0.001), and this difference persisted throughout follow up. Kaplan-Meier analysis demonstrated clear risk stratification across Fib-4 categories in both ACS and CCS. A higher Fib-4 index was independently associated with increased 3P-MACE risk after adjustment for C-reactive protein levels and coronary syndrome type (adjusted hazard ratio 1.15; 95% confidence interval 1.12-1.19; P<0.001).
CONCLUSIONS: The Fib-4 index efficiently stratifies cardiovascular risk in ACS and CCS, independent of systemic inflammation. ACS patients consistently exhibited lower Fib-4 values than CCS patients.
METHODS AND RESULTS: We analyzed 5,150 patients (ACS: 2,274; CCS: 2,876) from the Clinical Deep Data Accumulation System-Percutaneous Coronary Intervention (CLIDAS-PCI) database. The Fib-4 index was calculated 1-3 months post-PCI to avoid acute-phase transaminase elevation. Patients were stratified into low (<1.3), intermediate (1.3-2.67), and high (>2.67) Fib-4 categories. Longitudinal changes were assessed every 6 months for 2 years. The primary outcome was 3-point major adverse cardiovascular events (3P-MACE): cardiovascular death, non-fatal myocardial infarction, and stroke. Compared with CCS, ACS patients had fewer comorbidities and more intensive medical therapy. The Fib-4 index was lower in ACS than in CCS (1.83 vs. 1.93; P<0.001), and this difference persisted throughout follow up. Kaplan-Meier analysis demonstrated clear risk stratification across Fib-4 categories in both ACS and CCS. A higher Fib-4 index was independently associated with increased 3P-MACE risk after adjustment for C-reactive protein levels and coronary syndrome type (adjusted hazard ratio 1.15; 95% confidence interval 1.12-1.19; P<0.001).
CONCLUSIONS: The Fib-4 index efficiently stratifies cardiovascular risk in ACS and CCS, independent of systemic inflammation. ACS patients consistently exhibited lower Fib-4 values than CCS patients.