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Liver Fibrosis Scoring Systems as Novel Tools for Predicting Cardiovascular Outcomes in Patients Following Elective
Hui-Hui Liu1, Ye-Xuan Cao1, Jing-Lu Jin1
1State Key Laboratory of Cardiovascular Disease FuWai HospitalNational Center for Cardiovascular DiseasesNational Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
Insights
High liver fibrosis scores (LFSs) predict adverse cardiovascular events in patients after percutaneous coronary intervention (PCI). These scores can improve risk assessment for stable coronary artery disease patients undergoing PCI.
Area of Science:
- Cardiology
- Hepatology
- Preventive Medicine
Background:
- Previous studies link liver fibrosis scores (LFSs) to cardiovascular outcomes in various cardiovascular diseases.
- The prognostic value of LFSs in patients after percutaneous coronary intervention (PCI) remains largely unexplored.
- Stable coronary artery disease (CAD) patients undergoing PCI represent a critical population for risk stratification.
Purpose of the Study:
- To investigate the predictive capability of noninvasive LFSs for long-term cardiovascular outcomes in patients with stable CAD post-elective PCI.
- To determine if LFSs can enhance existing cardiovascular risk models in this patient cohort.
- To explore the potential application of LFSs in pre-procedural risk stratification before PCI.
Main Methods:
- A multicenter, prospective study enrolled 4003 patients with stable CAD undergoing PCI.
- Eight noninvasive LFSs were assessed for each participant.
- Patients were followed for major adverse cardiovascular events (MACE), including cardiovascular death, myocardial infarction, and stroke.
Main Results:
- Over a median follow-up of 5.0 years, 315 MACE (7.87%) occurred.
- Higher LFSs (intermediate/high) were associated with an increased risk of MACE (adjusted HRs 1.57–1.92).
- Specific LFSs, including NAFLD fibrosis score, FIB-4, and BARD, significantly improved risk prediction when added to established risk factors.
Conclusions:
- Elevated LFSs are associated with poor prognosis in stable CAD patients post-PCI.
- Noninvasive LFSs demonstrate potential utility in refining risk stratification before elective PCI.
- Integrating LFSs into risk assessment could optimize patient management and preventive strategies.
Abstract:
Background Previous studies have suggested a strong association of liver fibrosis scores (LFSs) with cardiovascular outcomes in patients with different cardiovascular diseases. Nonetheless, it is basically blank regarding the prognostic significance of LFSs in patients following percutaneous coronary intervention (PCI). This study sought to examine the potential role of LFSs in predicting long-term outcomes in a large cohort of patients with stable coronary artery disease after elective PCI. Methods and Results In this multicenter, prospective study, we consecutively enrolled 4003 patients with stable coronary artery disease undergoing PCI. Eight currently available noninvasive LFSs were assessed for each subject. All patients were followed up for the occurrence of cardiovascular events including cardiovascular death, nonfatal myocardial infarction, and stroke. During an average follow-up of 5.0±1.6 years, 315 (7.87%) major cardiovascular events were recorded. Subjects who developed cardiovascular events were more likely to have intermediate or high LFSs, including nonalcoholic fatty liver disease fibrosis score; fibrosis-4 score; body mass index, aspartate aminotransferase/alanine aminotransferase ratio, diabetes mellitus score (BARD); and aspartate aminotransferase/alanine aminotransferase ratio. Furthermore, compared with subjects with low scores, those with intermediate plus high score levels had significantly increased risk of cardiovascular events (adjusted hazard ratios ranging 1.57-1.92). Moreover, the addition of non-alcoholic fatty liver disease fibrosis score; fibrosis-4 score; or body mass index, aspartate aminotransferase/alanine aminotransferase ratio, diabetes mellitus score into a model with established cardiovascular risk factors significantly improved the prediction ability. Conclusions High LFSs levels might be useful for predicting adverse prognosis in patients with stable coronary artery disease following PCI, suggesting the possibility of the application of LFSs in the risk stratification before elective PCI.
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