{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:22:14Z","timestamp":1787570534178,"version":"build-2736575974"},"reference-count":22,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Cardiovasc. Dev. Dis.","JCDD"],"abstract":"<jats:p>Patients with chronic liver disease are systematically excluded from acute myocardial infarction (AMI) trials, and prior real-world data rely on administrative coding alone. Whether ICD-coded liver disease and laboratory-defined liver fibrosis identify the same patients, and whether they predict the same outcomes, is unknown. We conducted a single-center retrospective cohort study of 1037 consecutive adults admitted with AMI (ICD-10 I21.x) to a tertiary New York center between November 2022 and December 2024. The primary exposure was ICD-defined advanced liver disease (cirrhosis, hepatic failure, or portal hypertension\/decompensation; n = 102). The secondary, lab-based exposure was the Fibrosis-4 (FIB-4) index calculated from earliest admission AST, ALT, and platelet count (computable in 1031 patients, 99.4%), stratified as low (&lt;1.45), indeterminate (1.45\u20133.25), or advanced (&gt;3.25). Co-primary outcomes were invasive management (diagnostic angiography, percutaneous coronary intervention, or coronary artery bypass grafting) and in-hospital mortality. Multivariable logistic regression adjusted for age, sex, diabetes, chronic kidney disease, heart failure, and ST-elevation; the trend across FIB-4 tiers was assessed with the Cochran\u2013Armitage test. Denominators throughout (including the 168\/909 occult-fibrosis estimate) use the full exposure group as denominator under a missing-as-not-exposed convention; the four no-LD and two advanced-LD patients with missing FIB-4 are counted as non-advanced fibrosis for this calculation. Patients with ICD-defined advanced liver disease received invasive management less often (12.7% vs. 50.4%; adjusted odds ratio [aOR] 0.17, 95% CI 0.09\u20130.32) and died in hospital more often (43.1% vs. 7.9%; aOR 8.22, 95% CI 5.02\u201313.46) than patients without coded liver disease. Outcomes worsened monotonically across FIB-4 tiers (mortality 4.4% \u2192 9.2% \u2192 27.5%; invasive management 55.2% \u2192 45.6% \u2192 33.5%; both p &lt; 0.001 by Cochran\u2013Armitage trend test). Critically, 168 of 909 patients with no coded liver disease (18.5%) had FIB-4 &gt; 3.25, representing a substantial population of unrecognized advanced fibrosis missed by clinical coding. Coded liver disease identifies a small, severely affected subgroup with markedly lower rates of invasive management and 6- to 8-fold higher mortality after AMI. Routine FIB-4 calculation, a free, three-variable lab score, identifies a much larger population with occult advanced fibrosis and graded excess risk that ICD codes miss entirely. Pending prospective validation, FIB-4 may serve as a low-cost adjunct to bedside risk stratification in AMI care.<\/jats:p>","DOI":"10.3390\/jcdd13090408","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T10:07:53Z","timestamp":1787566073000},"page":"408","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Liver Disease, Liver Fibrosis, and the Invasive-Management Gap in Acute Myocardial Infarction: A Single-Center Cohort with Dual ICD and FIB-4 Stratification"],"prefix":"10.3390","volume":"13","author":[{"given":"Arun Gajan","family":"Pradeep","sequence":"first","affiliation":[{"name":"Department of Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Abdurrahman","family":"Butt","sequence":"additional","affiliation":[{"name":"Department of Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-8976-0411","authenticated-orcid":false,"given":"Kaiyu","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9301-8669","authenticated-orcid":false,"given":"Bishoy","family":"Beshay","sequence":"additional","affiliation":[{"name":"Department of Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Meng","sequence":"additional","affiliation":[{"name":"Department of Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saif","family":"Yasin","sequence":"additional","affiliation":[{"name":"Department of Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther","family":"Pearce","sequence":"additional","affiliation":[{"name":"Department of Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5704-3410","authenticated-orcid":false,"given":"Thomas","family":"Gut","sequence":"additional","affiliation":[{"name":"Department of Medicine, Staten Island University Hospital, Northwell Health, Staten Island, NY 10305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e771","DOI":"10.1161\/CIR.0000000000001328","article-title":"2025 ACC\/AHA\/ACEP\/NAEMSP\/SCAI Guideline for the Management of Patients with Acute Coronary Syndromes: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"151","author":"Rao","year":"2025","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"523","DOI":"10.3949\/ccjm.89a.21018","article-title":"Cirrhotic coagulopathy: A rebalanced hemostasis","volume":"89","author":"Singh","year":"2022","journal-title":"Cleve Clin. 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