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

Dogac Oksen; Muhammed H. Gecit; Zubeyir Bulat; Mehmet E. Gokce; Mehmet E. Bilgin; Sahra Balcioglu; Sukru Arslan; Veysel Oktay

doi:10.5114/aic.2025.153923

eISSN: 1897-4295
ISSN: 1734-9338

Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej

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abstract:

Original paper

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

Dogac Oksen

¹

,

Muhammed H. Gecit

²

,

Zubeyir Bulat

³

,

Mehmet E. Gokce

²

,

Mehmet E. Bilgin

²

,

Sahra Balcioglu

²

,

Sukru Arslan

²

,

Veysel Oktay

²

Medical Faculty, Altınbaş University, Istanbul, Turkey
Institute of Cardiology, Istanbul University Cerrahpasa, Istanbul, Turkey
Şırnak State Hospital, Sirnak, Turkey

Adv Interv Cardiol 2025; 21, 3 (81): 332–340

DOI: https://doi.org/10.5114/aic.2025.153923

Online publish date: 2025/08/31

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AMA

Oksen D, Gecit M, Bulat Z, et al. Comparative prognostic performance of the FIB-4 index versus SYNTAX and GRACE scores in predicting major cardiovascular events in acute coronary syndrome. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2025;21(3):332-340. doi:10.5114/aic.2025.153923.

APA

Oksen, D., Gecit, M., Bulat, Z., Gokce, M., Bilgin, M.,  & Balcioglu, S. et al. (2025). Comparative prognostic performance of the FIB-4 index versus SYNTAX and GRACE scores in predicting major cardiovascular events in acute coronary syndrome. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 21(3), 332-340. https://doi.org/10.5114/aic.2025.153923

Chicago

Oksen, Dogac, Muhammed H. Gecit, Zubeyir Bulat, Mehmet E. Gokce, Mehmet E. Bilgin, Sahra Balcioglu,  and Sukru Arslan et al. 2025. "Comparative prognostic performance of the FIB-4 index versus SYNTAX and GRACE scores in predicting major cardiovascular events in acute coronary syndrome". Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej 21 (3): 332-340. doi:10.5114/aic.2025.153923.

Harvard

Oksen, D., Gecit, M., Bulat, Z., Gokce, M., Bilgin, M., Balcioglu, S., Arslan, S.,  and Oktay, V. (2025). Comparative prognostic performance of the FIB-4 index versus SYNTAX and GRACE scores in predicting major cardiovascular events in acute coronary syndrome. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 21(3), pp.332-340. https://doi.org/10.5114/aic.2025.153923

MLA

Oksen, Dogac et al. "Comparative prognostic performance of the FIB-4 index versus SYNTAX and GRACE scores in predicting major cardiovascular events in acute coronary syndrome." Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, vol. 21, no. 3, 2025, pp. 332-340. doi:10.5114/aic.2025.153923.

Vancouver

Oksen D, Gecit M, Bulat Z, Gokce M, Bilgin M, Balcioglu S et al. Comparative prognostic performance of the FIB-4 index versus SYNTAX and GRACE scores in predicting major cardiovascular events in acute coronary syndrome. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2025;21(3):332-340. doi:10.5114/aic.2025.153923.

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 (p = 0.046). FIB-4 was an independent predictor of MACE (hazard ratio [HR]: 1.547; 95% CI: 1.169–2.046; p = 0.002). ROC analysis demonstrated superior prognostic accuracy for FIB-4 (area under the ROC curve: 0.693) over SYNTAX (0.609) and GRACE (0.552) scores. A Kaplan-Meier analysis showed significantly lower survival in the high FIB-4 group (p = 0.007).

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.

keywords:

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

Dogac Oksen 1 , Muhammed H. Gecit 2 , Zubeyir Bulat 3 , Mehmet E. Gokce 2 , Mehmet E. Bilgin 2 , Sahra Balcioglu 2 , Sukru Arslan 2 , Veysel Oktay 2

fibrosis, acute coronary syndrome, non-alcoholic fatty liver disease, risk, coronary artery disease

Dogac Oksen

¹

,

Muhammed H. Gecit

²

,

Zubeyir Bulat

³

,

Mehmet E. Gokce

²

,

Mehmet E. Bilgin

²

,

Sahra Balcioglu

²

,

Sukru Arslan

²

,

Veysel Oktay

²