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Objective <p>This study assessed the prognostic value of non-alcoholic fatty liver disease (NAFLD) in predicting major adverse cardiovascular events (MACE) in patients with suspected coronary artery disease (CAD), using coronary computed tomography angiography (CCTA) and CT-derived fractional flow reserve (CT-FFR).</p> Methods <p>In this retrospective study, patients who underwent both CCTA and non-contrast liver/spleen CT at Dalian Medical University First Affiliated Hospital from January 2017 to December 2018 were included. NAFLD was diagnosed via CT and clinical history. MACE included cardiovascular/cerebrovascular death, all-cause mortality, myocardial infarction, unstable angina hospitalization, unplanned revascularization, and stroke. Patients were divided into NAFLD and non-NAFLD groups. Cox regression assessed the association between NAFLD and MACE, adjusting for cardiovascular risk factors, CCTA findings, and CT-FFR results. Subgroup and time-dependent C-index analyses evaluated prognostic performance across populations and follow-up duration.</p> Results <p>Among 2,981 patients (737 with NAFLD), 408 experienced MACE over a median 68-month of follow-up. The NAFLD group had higher CAD-RADS scores, high-risk plaque, coronary calcification, and CT-FFR positivity, all <i>p</i> &lt; 0.05. NAFLD independently predicted MACE (adjusted HR: 1.39; 95% CI: 1.15, 1.73; <i>p</i> &lt; 0.001), especially in males, smokers, hypertensive and non-diabetic patients, and those with non-obstructive CAD or normal CT-FFR. Including NAFLD improved model performance at all time points, with C-index at 60 months of 0.753 vs. 0.727 (model2) and 0.695 (model 1), <i>p</i> &lt; 0.001.</p> Conclusion <p>NAFLD serves as an independent prognostic indicator for MACEs in patients with suspected CAD. The incorporation of NAFLD into risk stratification models significantly enhances predictive accuracy, especially within high-risk sub-populations.</p>

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Assessment of non-alcoholic fatty liver disease in suspected coronary artery disease patients: prognostic value and incremental predictive utility over cardiovascular risk factors and CCTA

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月29日

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  • Changqin Jiang,
  • Qing Yang,
  • Xueyan Hou,
  • Mengnan Zhang,
  • Zhiqiang Yang,
  • Ruili Qin,
  • Xixia Sun,
  • Xiaoling Tao,
  • Qiang Feng,
  • Zhaoqian Wang

摘要

Objective

This study assessed the prognostic value of non-alcoholic fatty liver disease (NAFLD) in predicting major adverse cardiovascular events (MACE) in patients with suspected coronary artery disease (CAD), using coronary computed tomography angiography (CCTA) and CT-derived fractional flow reserve (CT-FFR).

Methods

In this retrospective study, patients who underwent both CCTA and non-contrast liver/spleen CT at Dalian Medical University First Affiliated Hospital from January 2017 to December 2018 were included. NAFLD was diagnosed via CT and clinical history. MACE included cardiovascular/cerebrovascular death, all-cause mortality, myocardial infarction, unstable angina hospitalization, unplanned revascularization, and stroke. Patients were divided into NAFLD and non-NAFLD groups. Cox regression assessed the association between NAFLD and MACE, adjusting for cardiovascular risk factors, CCTA findings, and CT-FFR results. Subgroup and time-dependent C-index analyses evaluated prognostic performance across populations and follow-up duration.

Results

Among 2,981 patients (737 with NAFLD), 408 experienced MACE over a median 68-month of follow-up. The NAFLD group had higher CAD-RADS scores, high-risk plaque, coronary calcification, and CT-FFR positivity, all p < 0.05. NAFLD independently predicted MACE (adjusted HR: 1.39; 95% CI: 1.15, 1.73; p < 0.001), especially in males, smokers, hypertensive and non-diabetic patients, and those with non-obstructive CAD or normal CT-FFR. Including NAFLD improved model performance at all time points, with C-index at 60 months of 0.753 vs. 0.727 (model2) and 0.695 (model 1), p < 0.001.

Conclusion

NAFLD serves as an independent prognostic indicator for MACEs in patients with suspected CAD. The incorporation of NAFLD into risk stratification models significantly enhances predictive accuracy, especially within high-risk sub-populations.