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 ≥1.3, low P P = .004). Patients with both high FIB-4 and NAFLD demonstrated worst outcomes (HR: 3.12, 95% CI: 1.87-5.21, P < .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.
Küçükukur et al. (2026) studied this question.