Premium
Long‐term clinical outcomes after fatty liver screening in patients undergoing coronary angiogram: A prospective cohort study
Author(s) -
Wong Vincent WaiSun,
Wong Grace LaiHung,
Yeung Judy ChingLam,
Fung Chloe YukKiu,
Chan Jasmine KaLei,
Chang Zoe HoiYi,
Kwan Chelsia TszYan,
Lam HiuWan,
Limquiaco Jenny,
Chim Angel MeiLing,
Yu CheukMan,
Chan Henry LikYuen
Publication year - 2016
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.28253
Subject(s) - medicine , percutaneous coronary intervention , hazard ratio , myocardial infarction , cardiology , prospective cohort study , coronary artery disease , nonalcoholic fatty liver disease , fatty liver , diabetes mellitus , confidence interval , disease , endocrinology
There is ongoing debate on whether screening for nonalcoholic fatty liver disease (NAFLD) is worthwhile in high‐risk groups. Because of shared risk factors, NAFLD is highly prevalent in patients with coronary artery disease. We aimed to test the hypothesis that NAFLD screening in patients requiring coronary angiogram would identify high‐risk patients and predict long‐term clinical outcomes. This was a prospective cohort study. NAFLD screening was performed by abdominal ultrasonography before coronary angiogram in 612 consecutive patients. At baseline, 356 (58.2%) patients had NAFLD. NAFLD patients, compared with those without, were more likely to have >50% stenosis in one or more coronary arteries (84.6% vs. 64.1%; P < 0.001) and therefore require percutaneous coronary intervention (68.3% vs. 43.4%; P < 0.001). During 3,679 patient‐years of follow‐up, 47 (13.2%) NAFLD patients and 59 (23.0%) patients without NAFLD died (age‐ and sex‐adjusted hazard ratio [aHR]: 0.36; 95% confidence interval [CI]: 0.18‐0.70; P = 0.003). Composite cardiovascular outcomes (cardiovascular deaths, nonfatal myocardial infarction, heart failure, or secondary interventions) were similar between groups (36.5% vs. 37.1%; aHR, 0.90; 95% CI: 0.69‐1.18). Older age and diabetes were the only independent factors associated with cardiovascular events. Only 2 patients, both in the NAFLD group, died of primary liver cancer. No other patients developed liver‐related complications. Conclusion : In patients with clinical indications for coronary angiogram, the presence of NAFLD is associated with coronary artery stenosis and need for coronary intervention, but not increased mortality or cardiovascular complications. Liver cancer and cirrhotic complications are rare. Our data do not support NAFLD screening in this patient group at present, but studies with a longer duration of follow‐up are needed. (H epatology 2016;63:754–763)