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Articles
Gastroenterology and hepatology

Kardiologia Polska

Fibrosis-4 index is independently associated with poor coronary collateral development and lesion complexity in chronic total occlusion: A single-center cohort study

24 September 2026Original research1 min read

By Özdemir Kuzucu, Oğulcan Özdemir and Kutluhan Eren Hazır.

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Abstract
Keywords
Authors
Source

Abstract

Background

The fibrosis-4 (FIB-4) index, a non-invasive liver fibrosis index, has not been studied in chronic total occlusion (CTO).

Aims

Our aim was to examine whether FIB-4 is associated with poor collateral development, lesion complexity, and procedural outcomes.

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Methods

Consecutive patients with angiographically confirmed CTO (December 2023–April 2026) were analyzed; those with chronic liver disease or acute hepatic injury were excluded. FIB-4 was categorized as low (<1.3), intermediate (1.3–2.67), or high (>2.67). Collateral was graded by three blinded readers (Rentrop and Werner classifications). The primary outcome was poor collateral (Rentrop 0–1); logistic regression was adjusted for age, diabetes, estimated glomerular filtration rate, ejection fraction, multivessel disease, and J-CTO score.

Results

Of 193 patients, poor collateral prevalence rose across FIB-4 strata (31.9%, 42.1%, 80.8%; P <0.001). Per-unit FIB-4 was independently associated with poor collateral (adjusted odds ratio, 1.71; 95% confidence interval, 1.19–2.47; P = 0.004) and with high lesion complexity (J-CTO score ≥2: adjusted odds ratio, 2.43; P = 0.001); the estimate was attenuated but remained significant after adjustment for body mass index, smoking, C-reactive protein, statin use, and platelet count, and was consistent in multiple imputation. Adding FIB-4 to a clinical model improved discrimination (area under the curve 0.65 to 0.72, optimism-corrected 0.60 to 0.67; DeLong P = 0.02). Procedural success declined across strata. Among 181 patients with completed follow-up, FIB-4 was not associated with one-year major adverse cardiovascular events (adjusted hazard ratio, 1.13; P = 0.22).

Conclusions

Higher FIB-4 shows a graded association with poor collateral development, greater lesion complexity, and lower procedural success in CTO, but not with 1-year outcomes.

Keywords

Liver Disease Diagnosis and Treatment
Lesion
Odds ratio
Hazard ratio
Collateral circulation
Collateral
Logistic regression
Cohort study
Confidence interval
Open access

Authors

Özdemir Kuzucu
Oğulcan Özdemir
Kutluhan Eren Hazır

Source

Published in Kardiologia Polska. The abstract is shown as published and remains the work of its authors; read the full article at the source.

doi.org/10.33963/v.phj.114947

Prognia lists this article for reference and education. It is not medical advice. Always read the original and follow current guidelines and local protocols before acting on it.

At a glance

Journal: Kardiologia Polska
Type: Original research
Published: 24 September 2026
Specialty: Gastroenterology and hepatology
Read time: 1 min
Authors: 3
DOI: 10.33963/v.phj.114947

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