Comparative prognostic performance of the FIB-4 index versus SYNTAX and GRACE scores in predicting major cardiovascular events in acute coronary syndrome.

Introduction: The Fibrosis-4 (FIB-4) index, a non-invasive marker of liver fibrosis originally developed for non-alcoholic fatty liver disease (NAFLD), has gained attention for its prognostic value in cardiovascular disease. Aim: Given the shared metabolic risk between NAFLD and acute coronary syndrome (ACS), this study aimed to evaluate the association between FIB-4 and major adverse cardiovascular events (MACE) in patients with ACS, in comparison with conventional risk scores. Material and methods: This is an observational cohort study included 941 patients hospitalized with ACS between 2017 and 2021. Patients were classified into three FIB-4 categories: low, < 1.45; intermediate, 1.45-3.25; and high, ≥ 3.25. Clinical, laboratory, angiographic, and echocardiographic data were collected. MACE incidence was evaluated over a median follow-up of 67.5 months. Cox regression and receiver operating characteristic (ROC) analyses were performed. Results: MACE occurred in 37.9% of patients in the high FIB-4 group, compared to 28.7% and 29.2% in the low and intermediate groups, respectively ( Conclusions: The FIB-4 index is a robust, accessible predictor of adverse cardiovascular outcomes in ACS and may enhance conventional risk stratification strategies by integrating systemic metabolic burden into cardiovascular risk assessment.