Prognostic Value of Non-Invasive Hepatic Fibrosis Scores Across Acute Coronary Syndrome Subtypes

Hepatic fibrosis indices have emerged as potential prognostic markers in cardiovascular disease. This observational study included 760 consecutive patients with acute coronary syndrome (STEMI, NSTEMI, and unstable angina pectoris) admitted between March 2020 and May 2024 to evaluate the distribution of APRI, FIB-4, FIB-5, and FIB-6 across ACS subtypes and their predictive value for in-hospital mortality and cardiogenic shock. Fibrosis indices were calculated from admission laboratory values, and multivariate logistic regression and ROC curve analyses were performed. STEMI patients had significantly higher APRI (0.95±1.43 vs. 0.41±0.71 vs. 0.20±0.11), FIB-4 (3.68±4.03 vs. 1.98±2.17 vs. 1.17±0.52), and FIB-5 (5.16±1.08 vs. 4.66±0.84 vs. 4.38±0.43) than NSTEMI and unstable angina patients (all p<0.001). In-hospital mortality and cardiogenic shock occurred in 3.8% and 3.2% of patients, respectively. Cardiogenic shock, reduced left ventricular ejection fraction, and lower serum albumin independently predicted mortality, whereas older age independently predicted cardiogenic shock. None of the hepatic fibrosis indices independently predicted either outcome, and their discriminative performance was limited (AUC 0.526-0.632 for mortality and 0.570-0.662 for cardiogenic shock). These findings indicate that although hepatic fibrosis scores are elevated in STEMI, they primarily reflect the severity of acute myocardial injury rather than providing incremental prognostic value beyond established clinical predictors in patients with acute coronary syndrome.