Patients with acute coronary syndrome (ACS) still experience a high rate of morbidity and mortality despite optimal medical and interventional treatments. A growing body of evidence suggest that liver fibrosis (LF) is a risk factor of increased mortality in different clinical chronic diseases. The most common reasons accounting for LF are represented by cardio-metabolic risk factors, which are also frequently found in ACS patients. However, the presence of LF and its impact on clinical outcomes in patients with ACS have not been previously investigated. The main objectives of the study will be to:
- estimate the prevalence of liver fibrosis in a large cohort of consecutive patients with acute coronary syndromes (ACS) through the estimation of non-invasive scores of LF namely APRI and FIB-4 scores;
- evaluate the relationship between the presence of liver fibrosis and the extent and severity of coronary artery disease in patients undergoing percutaneous transluminal coronary angioplasty;
- investigate the relationship between LF and the incidence of in-hospital outcomes in ACS patients, such as cardiogenic shock and death.
Despite the presence of liver fibrosis has been recognized as a negative prognostic factor in patients with chronic liver disease, its role in patients at risk or with established cardiovascular disease is less clear.
Patients with coronary artery disease have frequently associated metabolic risk factors which may account for an increased risk of liver steatosis and fibrosis. However, so far, no study investigated the presence of liver fibrosis in patients with acute coronary syndrome (ACS) and no data on the association between liver fbrosis, the severity of coronary disease and the in-hospital incidence of adverse events are available.
This study will be the first to investigate these aspects in a large cohort of ACS patients enrolled at multiple Departments of Sapienza University of Rome.
Our findings will help to explain the residual cardiovascular risk of ACS patients and will identify a subgroup of patients at higher risk of death.
Our proposal of using simple non-invasive scores to detect liver fibrosis has multiple advantages, such as
1) to provide clinicians with an easy and cost-effective tool to early identify patients with liver fibrosis that can be routinely used in clinical practice using common laboratory values
2) to rapidly identify patients who may benefit from a second-level diagnostic strategy inlcuding imaging (fibroscan and liver magnetic resonance) or liver biopsy
3) to identify patients at higher risk of complications that may need a more aggressive therapeutic strategy and a closer follow-up after the procedure