Open AccessIncremental prognostic value of non-alcoholic fatty liver disease over coronary computed tomography angiography findings in patients with suspected coronary artery disease
Author(s) -
Keishi Ichikawa,
Toru Miyoshi,
Kazuhiro Osawa,
Takashi Miki,
H. Toda,
Kentaro Ejiri,
Masashi Yoshida,
Kazufumi Nakamura,
Hiroshi Morita,
Hiroshi Ito
Publication year - 2021
Publication title -
european journal of preventive cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.669
H-Index - 101
eISSN - 2047-4881
pISSN - 2047-4873
DOI - 10.1093/eurjpc/zwab120
Subject(s) - medicine , mace , coronary artery disease , hazard ratio , cardiology , acute coronary syndrome , framingham risk score , myocardial infarction , radiology , confidence interval , percutaneous coronary intervention , disease
Aims This study aimed to investigate additional risk stratification benefits of hepatic steatosis (HS) concurrently assessed during coronary computed tomography angiography (CTA) in a large patient cohort with suspected stable coronary artery disease (CAD). Methods and results In this prospective study, 1148 Japanese outpatients without a history of CAD who underwent coronary CTA for suspected stable CAD (mean age 64 ± 14 years) were included. HS, defined on CT as a hepatic-to-spleen attenuation ratio of <1.0, was examined just before the evaluation of adverse CTA findings, defined as obstructive and/or high-risk plaque. The major adverse cardiac events (MACE) were the composite of cardiac death, acute coronary syndrome, and late revascularization. The incremental predictive value of HS was evaluated using the global χ2 test and C-statistic. HS was identified in 247 (22%) patients. During a median follow-up of 3.9 years, MACE was observed in 40 (3.5%) patients. HS was significantly associated with MACE in a model that included adverse CTA findings (hazard ratio 4.01, 95% confidence interval 2.12–7.59, P < 0.001). By adding HS to the Framingham risk score and adverse CTA findings, the global χ2 score and C-statistic significantly increased from 29.0 to 49.5 (P < 0.001) and 0.74 to 0.81 (P = 0.026), respectively. In subgroup analyses in patients with diabetes mellitus and metabolic syndrome, HS had significant additive predictive value for MACE over the Framingham risk score and adverse CTA findings. Conclusion In patients with suspected stable CAD, concurrent evaluation of HS during coronary CTA enables more accurate detection of patients at higher risk of MACE.