{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:52:52Z","timestamp":1791910372973,"version":"4.3.4"},"reference-count":34,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Angiology"],"abstract":"<jats:p>\n                    Myocardial infarction with non-obstructive coronary arteries (MINOCA) represents 5% to 10% of acute myocardial infarction cases. The Fibrosis-4 (FIB-4) index and non-alcoholic fatty liver disease (NAFLD) are emerging markers of systemic inflammation and metabolic dysfunction, yet their prognostic role in MINOCA remains unexplored. This prospective cohort study included 472 consecutive MINOCA patients from a tertiary cardiac center between September 2022 and October 2025. Patients were stratified by FIB-4 index (high \u22651.3, low &lt;1.3). NAFLD was diagnosed using hepatic steatosis index. The primary endpoint was major adverse cardiovascular events (MACE): cardiovascular death, recurrent myocardial infarction, urgent revascularization, or hospitalization for heart failure or arrhythmia during 36-month follow-up. High FIB-4 index was independently associated with increased MACE risk (hazard ratio [HR]: 2.34, 95% confidence interval [CI]: 1.45-3.78,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009&lt;\u2009.001). NAFLD presence further augmented this risk (HR: 1.89, 95% CI: 1.23-2.91,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009=\u2009.004). Patients with both high FIB-4 and NAFLD demonstrated worst outcomes (HR: 3.12, 95% CI: 1.87-5.21,\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u2009&lt;\u2009.001). FIB-4 showed good discriminative ability for MACE prediction (AUC: 0.712, 95% CI: 0.665-0.759). FIB-4 index and NAFLD are independent predictors of adverse outcomes in MINOCA patients, offering simple, cost-effective tools for risk stratification.\n                  <\/jats:p>","DOI":"10.1177\/00033197261427829","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T10:54:03Z","timestamp":1773312843000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Prognostic Value of FIB-4 Index and Non-Alcoholic Fatty Liver Disease in Myocardial Infarction With Non-Obstructive Coronary Arteries: A Prospective Cohort Study"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7846-6391","authenticated-orcid":false,"given":"Murat","family":"K\u00fc\u00e7\u00fckukur","sequence":"first","affiliation":[{"name":"Department of Cardiology, Izmir City Hospital, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3667-2775","authenticated-orcid":false,"given":"R\u0131dvan","family":"Binici","sequence":"additional","affiliation":[{"name":"Department of Radiology, Izmir City Hospital, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,12]]},"reference":[{"issue":"3","key":"e_1_3_3_2_2","first-page":"143","article-title":"ESC working group position paper on myocardial infarction with non-obstructive coronary arteries","volume":"38","author":"Agewall S","year":"2017","unstructured":"Agewall S, Beltrame JF, Reynolds HR, et al. ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. 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Clinical significance of fatty liver in patients with myocardial infarction with non-obstructive coronary arteries. Atherosclerosis. 2018;272:50-55.","journal-title":"Atherosclerosis"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-150-9-200905050-00006"},{"issue":"4","key":"e_1_3_3_16_2","first-page":"378","article-title":"Predictors of adverse outcome in patients with myocardial infarction with non-obstructive coronary artery disease: a Swedish nationwide cohort study","volume":"8","author":"Nordenskj\u00f6ld AM","year":"2019","unstructured":"Nordenskj\u00f6ld AM, Baron T, Eggers KM, Jernberg T, Lindahl B. Predictors of adverse outcome in patients with myocardial infarction with non-obstructive coronary artery disease: a Swedish nationwide cohort study. Eur Heart J Acute Cardiovasc Care. 2019;8(4):378-385.","journal-title":"Eur Heart J Acute Cardiovasc Care"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa575"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2022.110206"},{"issue":"5","key":"e_1_3_3_19_2","first-page":"1234","article-title":"FIB-4, a surrogate marker of liver fibrosis, predicts mortality and adverse events after acute myocardial infarction","volume":"20","author":"Leylek H","year":"2025","unstructured":"Leylek H, Durak VA, Koksal O. FIB-4, a surrogate marker of liver fibrosis, predicts mortality and adverse events after acute myocardial infarction. Intern Emerg Med. 2025;20(5):1234-1242.","journal-title":"Intern Emerg Med"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(21)00308-3"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(14)70032-4"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-019-00898-6"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.11.050"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00392-020-01709-7"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.atherosclerosis.2019.01.029"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.102.17.2031"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.163.19.2345"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00536-5"},{"issue":"3","key":"e_1_3_3_29_2","first-page":"466","article-title":"Cardiovascular and mortality outcomes with GLP-1 receptor agonists vs other glucose-lowering drugs in individuals with NAFLD and type 2 diabetes: a large population-based matched cohort study","volume":"67","author":"Li CX","year":"2024","unstructured":"Li CX, Liang S, Gao L, Liu H. Cardiovascular and mortality outcomes with GLP-1 receptor agonists vs other glucose-lowering drugs in individuals with NAFLD and type 2 diabetes: a large population-based matched cohort study. Diabetologia. 2024;67(3):466-478.","journal-title":"Diabetologia"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)61272-X"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2015.05.006"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29367"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(19)30383-8"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2020-322786"},{"key":"e_1_3_3_35_2","first-page":"139","article-title":"Epicardial adipose tissue in cardiovascular disease and NAFLD","volume":"30","author":"Iacobellis G.","year":"2023","unstructured":"Iacobellis G. Epicardial adipose tissue in cardiovascular disease and NAFLD. Curr Opin Endocrinol Diabetes Obes. 2023;30:139-146.","journal-title":"Curr Opin Endocrinol Diabetes Obes"}],"container-title":["Angiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00033197261427829","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00033197261427829","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00033197261427829","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T10:23:10Z","timestamp":1777371790000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00033197261427829"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,12]]},"references-count":34,"alternative-id":["10.1177\/00033197261427829"],"URL":"https:\/\/doi.org\/10.1177\/00033197261427829","relation":{},"ISSN":["0003-3197","1940-1574"],"issn-type":[{"value":"0003-3197","type":"print"},{"value":"1940-1574","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,12]]},"article-number":"00033197261427829"}}