Liver Fibrosis and the Risk of Coronary Artery Disease, Stent Thrombosis, Restenosis and Adverse Clinical Outcomes

Background and Aims: Liver fibrosis may be associated with coronary artery disease (CAD) and adverse cardiovascular outcomes, but data remain limited. This study aimed to explore the relationship between liver fibrosis and the incidence of CAD, stent thrombosis (ST), in-stent restenosis (ISR) and long-term clinical outcomes. Methods: Two cohorts were analysed: the UK Biobank (UKB) cohort examined liver fibrosis and CAD incidence and clinical outcomes in the general population, while the Wenzhou cohort assessed its relationship with ST and ISR and long-term outcomes in post-PCI patients. CAD incidence was defined as coronary stenosis >= 50% or clinical events, such as myocardial ischaemia, myocardial infarction and acute coronary syndrome. ST was confirmed via angiography, and ISR was defined as >= 50% stenosis within the stent. Major adverse cardiovascular events (MACE) included all-cause mortality, myocardial infarction, heart failure and stroke. Liver fibrosis was assessed using FIB-4, categorised as <= 1.3, 1.3-2.67 and > 2.67. Results: 394,625 participants were included. In the UKB cohort (n = 380,638), 7102 (1.9%) had FIB-4 > 2.67. Over 14.4 years, FIB-4 > 2.67 was associated with higher CAD incidence (aHR = 1.41, p < 0.001) and MACE (aHR = 1.69, p < 0.001). In the Wenzhou cohort (n = 13,987), 3173 (22.7%) had FIB-4 > 2.67. Over 3.0 years, FIB-4 > 2.67 was associated with increased risks of ST and ISR (aHR = 1.34, p = 0.001) and MACE (aHR = 1.97, p < 0.001). Conclusions: Liver fibrosis is common among patients with CAD and is associated with CAD incidence, stent thrombosis, restenosis and long-term cardiovascular risk.