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Aims The prognostic role of liver fibrosis (LF) in acute coronary syndrome (ACS) patients is unclear. Biochemical markers and scoring systems, such as the APRI score and the FIB-4 score, have recently been shown to be reliable in predicting LF. We aimed to investigate the relationship between LF and in-hospital outcomes in consecutive ACS patients. Methods and results The REALE-ACS is a real-world monocentric observational study to investigate characteristics, management and outcomes of patients admitted for ACS from January 2016 to January 2020. LF was defined by an APRI score &amp;gt;0.70 and FIB-4 score &amp;gt;3.25. We investigated the association of APRI and FIB-4 with in-hospital adverse events (AEs) defined as cardiogenic shock and death. 469 consecutive ACS patients were included. Mean age was 65.7 ± 13.0 years and 108 (23%) were women. Overall, 7.9% of patients had LF. STEMI was more common in LF patients (86.5% vs. 40.8%, P &amp;lt; 0.001). Patients with LF had lower hypertension (64.9% vs. 81.7%, P = 0.015), and higher GRACE score upon admission (155.3 ± 48.4 vs. 131.6 ± 38.9, P = 0.001). Higher serum levels of aspartate aminotransferase [242 (184.5–363) vs. 22 (17–34), P &amp;lt; 0.001], alanine aminotransferase [67 (51.5–115) vs. 20 (15–29), P &amp;lt; 0.001], white blood cells [12 000 (10 145–14 350) vs. 8935 (7262.5–11 267), P &amp;lt; 0.001], percentage of neutrophils (97.3 ± 104.5 vs. 68.5 ± 13.7, P &amp;lt; 0.001), D-dimer [1039 (435.5–2100) vs. 436 (275–894), P &amp;lt; 0.001], and lower percentage of lymphocytes (12.3 ± 6.0 vs. 21.7 ± 11.21, P &amp;lt; 0.001) were reported in LF patients. Globally, 49 AEs were recorded. At stepwise multivariable logistic regression analysis including clinical and biochemical factors, COPD [odds ratio (OR): 2.47, 95% confidence interval (CI): 1.15–5.29, P = 0.020], HS-troponin levels (OR: 2.05, 95% CI: 1.02–4.10, P = 0.043), and APRI &amp;gt; 0.70 (OR: 2.58, 95% CI: 1.07–6.22, P = 0.035) were associated with AEs. Conclusions ACS patients with LF have a high STEMI rate and are at higher risk of worse in-hospital AEs. Our findings suggest that LF may contribute to the identify ACS patients at high-risk for adverse events and mortality.

european heart journal supplements

231 In-hospital outcomes following an acute coronary syndrome in patients with liver fibrosis: results from the real-world observational registry of acute coronary syndromes (REALE-ACS)