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Introduction Liver function tests (LFTs) are frequently performed in patients admitted with acute coronary syndrome (ACS), often daily, despite limited evidence supporting their routine use in clinically stable cases. LFT abnormalities during ACS are typically transient and non-specific for hepatic pathology. 1 In stable ACS patients, LFTs rarely influence management in the absence of clinical indications. For initiating statin therapy, guidelines recommend treatment provided baseline transaminases are less than three times the upper limit of normal.2 With increasing service pressures and the drive for value-based care, reducing unnecessary biochemical testing represents an opportunity for cost savings without compromising patient safety.Methods We audited all consecutive ACS admissions requiring primary or emergency percutaneous coronary intervention (PCI) at the Golden Jubilee National Hospital in Clydebank, during June 2024. Clinically stable patients – defined as those not requiring cardiovascular support after initial assessment and revascularisation – were identified. The frequency of LFTs during admission was recorded, and local laboratory tariffs were applied to estimate cost. Parameters analysed included bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT). Clinical outcomes assessed were significant hepatic dysfunction requiring further investigation or intervention, resolution of LFT abnormalities, and 30-day post-discharge outcomes.Results A total of 105 patients were identified ( table 1; mean age 64 ± 12 years; 71% male; median length of stay 3 days). During admission, 531 LFTs were performed (median 3 tests per patient), costing £5,564.88 (£10.48 per test; figure 1). Notably, 100/105 (95%) patients underwent same-day or daily LFTs despite clinical stability, representing 351 potentially avoidable tests if targeted or alternate-day testing had been used. This equated to £3,678.48 in potential savings over one month, or approximately £44,000 per year. Overall, 91/105 (87%) patients had at least one abnormal LFT – most commonly AST (figure 2) – without evidence of hepatic pathology. All abnormal LFTs resolved or improved by discharge without further investigation or intervention. High-intensity statins were initiated early in 100/105 (95%) patients. At 30-day follow-up, there were two deaths (one cardiac, one metastatic cancer) and seven readmissions (five cardiac, two urosepsis); all patients had normal LFTs.Conclusions Our data suggest that routine LFTs in clinically stable ACS patients did not influence management or outcomes and can be safely reduced. Measures are being implemented to promote targeted, clinically indicated testing that supports high-value care, reduces patient burden, and saves costs. These findings align with Choosing Wisely principles, 3 and wider adoption across the National Health Service could optimise resource use without compromising patient safety.Abstract 357 Table 1Patient demographics, diagnosis and clinical outcomes. SD, standard deviation; IQR, interquartile range; STEMI, ST-segment elevation myocardial infarction; LFT, liver function testPatient demographics, diagnosis and clinical outcomesPatient (n = 105)Age, years, mean (SD)64 (12)Length of stay, days, median (IQR)3 (3)Male, n (%)75/105 (71)STEMI, n (%)73/105 (70)Patients who had same-day or daily LFTs, n (%)100/105 (95)Patients who had at least one abnormal LFT, n (%)91/105 (87) Patients requiring hepatic investigation or intervention, n (%)0/91 (0) Patients with normalised or improving LFTs at discharge, n (%)91/91 (100) 30-day post-discharge mortality, n (%)0/91 (0)Abstract 357 Figure 1Potential cost savings of £3,678.48 could be achieved through targeted or alternate-day liver function testingAbstract 357 Figure 2Distribution of liver function test results by analyte (normal ranges: bilirubin <20 µmol/L; ALT <50 IU/L; AST <40 IU/L; GGT <90 IU/L). Overall, 351/531 (66%) LFT results were abnormal, all of which subsequently resolved without the need for hepatic investigation or intervention. ALT, alanine aminotransferase; AST, aspartate aminotransferase; GGT, gamma-glutamyl transferase