Abstract 4145760: Impact of the liver fibrosis scoring on prognosis after coronary artery bypass grafting in patients with prediabetes or diabetes

Background: Previous studies have suggested a strong association of liver fibrosis scores with cardiovascular outcomes in patients with different cardiovascular diseases, especially in people with abnormal glucose metabolism. However, the prognostic implication of liver fibrosis scores in patients with prediabetes or diabetes undergoing coronary artery bypass grafting (CABG) has not been investigated yet. Purpose: This study aimed to investigate the impact of liver fibrosis, assessed by the Fibrosis-4 (FIB-4) index on clinical outcomes following CABG in patients with prediabetes or diabetes. Methods: Adult patients with stable coronary artery disease and prediabetes or diabetes undergoing isolated CABG from a large prospective registry-based cohort between January 2013 and December 2018 at our center were consecutively included. Patients with missing detailed data, hepatitis B/C virus infection, autoimmune hepatitis, hereditary liver disease, secondary causes of fatty liver, drug-induced liver disease, active infections, or severe liver insufficiency were excluded. The primary outcome was all-cause death. The secondary outcome was major adverse cardiovascular and cerebrovascular events (MACCEs), defined as a composite of all-cause death, myocardial infarction, cerebrovascular accidents, or repeat revascularization. Survival was summarized using Kaplan-Meier curves and compared by log-rank test, followed by multiple adjustments. Results: A total of 14,253 patients were included. According to clinical guidelines, a FIB-4 score of ≤1.3 is considered indicative of a low risk for liver fibrosis. Of all patients, 8,888 (47.9%) were identified as having a high FIB-4 (>1.3) level. During a median follow-up of 3.4 years, a high FIB-4 level was associated with an increased risk of all-cause death (adjusted hazard ratio [aHR]: 1.405, 95% confidence interval [95% CI]: 1.205-1.698, P＜0.001), as well as MACCEs (aHR: 1.142, 95% CI: 1.039-1.256, P=0.006). Conclusion: Almost half of the patients with prediabetes or diabetes undergoing CABG were exposed to high FIB-4, which might be associated with poor prognosis.