Predictive value of the FIB-4 index in ST-elevation myocardial infarction patients: from admission to follow-up
Ayşe İrem Demirtola1, Anar Mammadli2, Gökhan Çiçek1
1Cardiology Department, University of Health Sciences, Ankara City Hospital, Ankara, Turkey.
Insights
The FIB-4 index predicts mortality in ST-elevation myocardial infarction (STEMI) patients undergoing PCI. Higher FIB-4 scores correlate with increased in-hospital and post-discharge mortality risks.
Area of Science:
- Cardiology
- Hepatology
- Biomarker Research
Background:
- ST-elevation myocardial infarction (STEMI) is a major cause of death globally.
- Primary percutaneous coronary intervention (PCI) has improved STEMI outcomes.
- The FIB-4 index, a liver fibrosis marker, shows potential cardiovascular associations.
Purpose of the Study:
- To assess the predictive value of the FIB-4 index for mortality in STEMI patients undergoing PCI.
- To determine if FIB-4 index can improve risk stratification in this population.
Main Methods:
- Retrospective analysis of 2186 STEMI patients who underwent PCI.
- Patients stratified into three groups based on FIB-4 index tertiles.
- Logistic regression and Cox proportional hazards models used for mortality prediction.
Main Results:
- Higher FIB-4 index tertiles were associated with significantly increased in-hospital mortality.
- The FIB-4 index independently predicted in-hospital mortality.
- Elevated FIB-4 index was linked to higher rates of all-cause mortality post-discharge and reduced survival.
Conclusions:
- The FIB-4 index is an independent predictor of both in-hospital and post-discharge mortality in STEMI patients undergoing PCI.
- Integrating the FIB-4 index may enhance risk stratification and patient management strategies.
Background:
ST-elevation myocardial infarction (STEMI) remains a leading cause of global mortality despite advancements in primary percutaneous coronary intervention (PCI). The fibrosis-4 (FIB-4) index, a non-invasive marker of liver fibrosis, has been associated with cardiovascular outcomes. However, its predictive value for in-hospital and post-discharge all-cause mortality in STEMI patients undergoing PCI remains uncertain. This study aimed to evaluate the prognostic utility of the FIB-4 index in this high-risk population.
Methods:
This retrospective study analysed 2186 STEMI patients who underwent PCI. Patients were categorised into three groups based on FIB-4 tertiles: Group 1 (FIB-4 < 4.52), group 2 (4.52 ≤ FIB-4 < 6.07), and group 3 (FIB-4 ≥ 6.07). Logistic regression assessed predictors of in-hospital mortality, while Kaplan-Meier's survival analysis and Cox proportional hazards models were used to evaluate post-discharge mortality.
Results:
In-hospital mortality was significantly higher in group 3 (4.3%) compared to group 2 and group 1 (p = .016). The FIB-4 index was an independent predictor of in-hospital mortality (OR: 1.105, 95% CI: 1.011-1.207, p = .028), alongside Killip class ≥ II, diabetes mellitus and reduced eGFR < 76.8 mL/min. During a median follow-up of 21 months post-discharge, all-cause mortality occurred in 8% of patients (n = 178), with rates highest in group 3 (10%, n = 74) compared to group 2 and group 1 (p = .002). Kaplan-Meier's survival analysis demonstrated significantly lower cumulative survival in group 3 (log-rank test, p = .003). Multivariable Cox analysis confirmed an increased post-discharge mortality risk in group 3 (HR: 1.862, 95% CI: 1.254-2.764, p = .002) compared to group 1.
Conclusions:
The FIB-4 index independently predicts in-hospital and post-discharge all-cause mortality in STEMI patients undergoing PCI. Its integration into clinical practice could improve risk stratification and patient management.
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