FIB-4 predicts coronary disease and early outcomes in unstable angina pectoris

Unstable angina pectoris (UAP) remains a frequent cause of emergency department (ED) admissions and carries a substantial risk of progression to myocardial infarction or major adverse cardiac events (MACE). Traditional risk scores may inadequately capture underlying systemic inflammation and fibrotic burden. The Fibrosis-4 (FIB-4) index, originally developed for non-invasive liver fibrosis assessment, has recently been linked to cardiovascular risk. The objective is to investigate the association between the FIB-4 index and angiographic coronary artery disease and short-term major adverse cardiovascular events in emergency department patients presenting with unstable angina pectoris. This prospective observational study included 262 adults diagnosed with UAP who underwent coronary angiography. Patients were categorized as having normal coronaries (Group 1) or CAD (Group 2). Demographic features, laboratory values, echocardiographic parameters, and clinical outcomes were recorded. Independent predictors of CAD were identified using binary logistic regression. Thirty-day MACE was assessed. CAD was present in 67.6% of patients. FIB-4 > 3.25 was independently associated with angiographic CAD (OR: 9.71; 95% CI 1.22-77.48; p = 0.032), along with higher triglyceride levels, lower HDL, and reduced LVEF. During follow-up, MACE occurred in 11.5% of patients and was significantly more frequent among those with FIB-4 > 3.25 (p < 0.001). No significant differences were observed in GRACE and HEART scores between patients with and without MACE. An FIB-4 > 3.25 was independently associated with the presence of angiographic CAD and a higher rate of short-term MACE in patients presenting with unstable angina pectoris. As a simple, inexpensive, and readily available biomarker, FIB-4 may provide complementary clinical information in the early evaluation of this population.