Association of Subclinical Liver Fibrosis With Death in Patients With Coronary Artery Disease: A Post Hoc Analysis of the ISCHEMIA Trial
Background The fibrosis‐4 index (FIB‐4) score, a noninvasive marker of subclinical liver fibrosis, has shown prognostic utility in general surgical populations. Current risk assessment models for patients with coronary artery disease undergoing percutaneous coronary intervention or coronary artery b...
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Wiley
2025-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.040848 |
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| author | Tulio Caldonazo Mohamed Rahouma Sigrid Sandner Bjorn Redfors Lamia Harik Markus Richter Hristo Kirov Torsten Doenst Mario F. L. Gaudino |
| author_facet | Tulio Caldonazo Mohamed Rahouma Sigrid Sandner Bjorn Redfors Lamia Harik Markus Richter Hristo Kirov Torsten Doenst Mario F. L. Gaudino |
| author_sort | Tulio Caldonazo |
| collection | DOAJ |
| description | Background The fibrosis‐4 index (FIB‐4) score, a noninvasive marker of subclinical liver fibrosis, has shown prognostic utility in general surgical populations. Current risk assessment models for patients with coronary artery disease undergoing percutaneous coronary intervention or coronary artery bypass grafting do not account for liver dysfunction apart from overt liver cirrhosis. We analyzed the distribution of the baseline FIB‐4 score and its association with all‐cause death in patients with coronary artery disease using data from the International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial. Methods The baseline FIB‐4 score was calculated for all ISCHEMIA randomized participants with laboratory data (platelet count, aspartate aminotransferase, and alanine aminotransferase). The primary outcome was the association between baseline FIB‐4 and all‐cause death. Secondary outcomes were cardiovascular death, heart failure, myocardial infarction, and stroke. Multivariable Cox regression was performed adjusting for key risk factors. Results The FIB‐4 score was calculated for 3735 participants. Baseline FIB‐4 score was significantly associated with an increased risk of all‐cause (hazard ratio [HR], 1.19 [95% CI, 1.07–1.32]; P=0.001) and cardiovascular death (HR, 1.19 [95% CI, 1.04–1.36]; P=0.011). This association was consistent across the overall population and within subgroups of patients treated with percutaneous coronary intervention, coronary artery bypass grafting, and medical therapy. There was no significant association regarding heart failure, myocardial infarction, and stroke. Conclusions The FIB‐4 score may be a significant predictor of death in patients with coronary artery disease. Preprocedural hepatic assessment should be considered to stratify risk in patients undergoing invasive cardiac procedures. |
| format | Article |
| id | doaj-art-5100c5e5c5e64097a76bc84255f20ab7 |
| institution | DOAJ |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-5100c5e5c5e64097a76bc84255f20ab72025-08-20T02:46:24ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-07-01141310.1161/JAHA.124.040848Association of Subclinical Liver Fibrosis With Death in Patients With Coronary Artery Disease: A Post Hoc Analysis of the ISCHEMIA TrialTulio Caldonazo0Mohamed Rahouma1Sigrid Sandner2Bjorn Redfors3Lamia Harik4Markus Richter5Hristo Kirov6Torsten Doenst7Mario F. L. Gaudino8Department of Cardiothoracic Surgery Jena University Hospital, Friedrich‐Schiller‐University Jena GermanyDepartment of Cardiothoracic Surgery Weill Cornell Medicine New York NY USADepartment of Cardiothoracic Surgery Weill Cornell Medicine New York NY USADepartment of Population Health Sciences Weill Cornell Medicine New York NY USADepartment of Cardiothoracic Surgery Weill Cornell Medicine New York NY USADepartment of Cardiothoracic Surgery Jena University Hospital, Friedrich‐Schiller‐University Jena GermanyDepartment of Cardiothoracic Surgery Jena University Hospital, Friedrich‐Schiller‐University Jena GermanyDepartment of Cardiothoracic Surgery Jena University Hospital, Friedrich‐Schiller‐University Jena GermanyDepartment of Cardiothoracic Surgery Weill Cornell Medicine New York NY USABackground The fibrosis‐4 index (FIB‐4) score, a noninvasive marker of subclinical liver fibrosis, has shown prognostic utility in general surgical populations. Current risk assessment models for patients with coronary artery disease undergoing percutaneous coronary intervention or coronary artery bypass grafting do not account for liver dysfunction apart from overt liver cirrhosis. We analyzed the distribution of the baseline FIB‐4 score and its association with all‐cause death in patients with coronary artery disease using data from the International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial. Methods The baseline FIB‐4 score was calculated for all ISCHEMIA randomized participants with laboratory data (platelet count, aspartate aminotransferase, and alanine aminotransferase). The primary outcome was the association between baseline FIB‐4 and all‐cause death. Secondary outcomes were cardiovascular death, heart failure, myocardial infarction, and stroke. Multivariable Cox regression was performed adjusting for key risk factors. Results The FIB‐4 score was calculated for 3735 participants. Baseline FIB‐4 score was significantly associated with an increased risk of all‐cause (hazard ratio [HR], 1.19 [95% CI, 1.07–1.32]; P=0.001) and cardiovascular death (HR, 1.19 [95% CI, 1.04–1.36]; P=0.011). This association was consistent across the overall population and within subgroups of patients treated with percutaneous coronary intervention, coronary artery bypass grafting, and medical therapy. There was no significant association regarding heart failure, myocardial infarction, and stroke. Conclusions The FIB‐4 score may be a significant predictor of death in patients with coronary artery disease. Preprocedural hepatic assessment should be considered to stratify risk in patients undergoing invasive cardiac procedures.https://www.ahajournals.org/doi/10.1161/JAHA.124.040848chronic coronary artery diseasecoronary artery bypass grafting (CABG)liver fibrosismedical therapypercutaneous coronary intervention (PCI) |
| spellingShingle | Tulio Caldonazo Mohamed Rahouma Sigrid Sandner Bjorn Redfors Lamia Harik Markus Richter Hristo Kirov Torsten Doenst Mario F. L. Gaudino Association of Subclinical Liver Fibrosis With Death in Patients With Coronary Artery Disease: A Post Hoc Analysis of the ISCHEMIA Trial Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease chronic coronary artery disease coronary artery bypass grafting (CABG) liver fibrosis medical therapy percutaneous coronary intervention (PCI) |
| title | Association of Subclinical Liver Fibrosis With Death in Patients With Coronary Artery Disease: A Post Hoc Analysis of the ISCHEMIA Trial |
| title_full | Association of Subclinical Liver Fibrosis With Death in Patients With Coronary Artery Disease: A Post Hoc Analysis of the ISCHEMIA Trial |
| title_fullStr | Association of Subclinical Liver Fibrosis With Death in Patients With Coronary Artery Disease: A Post Hoc Analysis of the ISCHEMIA Trial |
| title_full_unstemmed | Association of Subclinical Liver Fibrosis With Death in Patients With Coronary Artery Disease: A Post Hoc Analysis of the ISCHEMIA Trial |
| title_short | Association of Subclinical Liver Fibrosis With Death in Patients With Coronary Artery Disease: A Post Hoc Analysis of the ISCHEMIA Trial |
| title_sort | association of subclinical liver fibrosis with death in patients with coronary artery disease a post hoc analysis of the ischemia trial |
| topic | chronic coronary artery disease coronary artery bypass grafting (CABG) liver fibrosis medical therapy percutaneous coronary intervention (PCI) |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.040848 |
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