FIB-4, a surrogate marker of liver fibrosis, predicts mortality and adverse events after acute myocardial ınfarction.

The Fibrosis-4 (FIB-4) score is a simple, non-invasive index originally developed to assess liver fibrosis. Recently, it has gained attention as a potential prognostic marker in cardiovascular diseases. This study aimed to evaluate whether the FIB-4 score, independent of its role in liver assessment, can predict short-term mortality and major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI) undergoing coronary angiography (CAG) in the emergency department (ED). In this prospective observational study, 1017 patients diagnosed with AMI and treated with CAG between May 1, 2023, and February 29, 2024, were included. Patients were stratified into three groups based on FIB-4 score: low (< 1.45), intermediate (1.45-3.25), and high (> 3.25). Clinical and laboratory data, HEART scores, angiographic findings, in-hospital and 30-day outcomes were compared across groups. Patients with FIB-4 > 3.25 exhibited significantly higher rates of ST-elevation myocardial infarction (60.2%), hypertension (64%), diabetes mellitus (47.5%), atrial fibrillation (11%), and ventricular tachycardia (2.1%) (all p < 0.01). In-hospital mortality (14.4%), 30-day mortality (19.9%), and MACE (24.8%) were significantly elevated in this group (p < 0.001). Multivariate analysis identified FIB-4 > 3.25 (OR 3.816; p = 0.001), HEART score (OR 1.161; p = 0.013), and hemoglobin (OR 0.873; p = 0.038) as independent predictors of mortality. ROC analysis revealed moderate discriminative performance for FIB-4 (AUC: 0.693) and HEART score (AUC: 0.766). Elevated FIB-4 scores are independently associated with increased short-term mortality and adverse cardiovascular outcomes in AMI patients undergoing CAG. Beyond its traditional role in liver disease, the FIB-4 score may serve as a practical, non-invasive biomarker for early cardiovascular risk stratification in patients presenting to the ED with acute myocardial infarction.