Liver Fibrosis Scoring Systems as Novel Tools for Predicting Cardiovascular Outcomes in Patients Following Elective Percutaneous Coronary Intervention

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.

Keywords: coronary artery disease; liver fibrosis score; outcome; percutaneous coronary intervention; risk factor.

Figure 1. Flowchart Illustrating the Study Population.

ACS indicates acute coronary syndrome; CABG, coronary artery bypass grafting; and PCI, percutaneous coronary intervention.

Figure 2. The Cumulative Event‐Free Survival Analysis for Primary End Point According to Baseline LFSs.

(A) NFS; (B) FIB‐4; (C) BARD; (D) AST/ALT ratio; (E) Forns score; (F) GPR; (G) APRI; (H) HUI. ALT indicates alanine aminotransferase; APRI, AST to platelet ratio index; AST, aspartate aminotransferase; BARD, body mass index, AST/ALT ratio, diabetes mellitus score; FIB‐4, fibrosis‐4; GPR, gamma‐glutamyltransferase platelet ratio; and NFS, nonalcoholic fatty liver disease fibrosis score.