Effect of coded steatotic liver disease on outcomes of percutaneous coronary intervention in non-diabetic adults: insights from a multicenter real-world cohort

Background Metabolic dysfunction-associated steatotic liver disease (MASLD) is a cardiovascular risk–enhancing condition. Its prognostic significance following PCI in non-diabetic adults, and the temporal distribution of that risk, remain incompletely characterized. Objectives To evaluate whether coded steatotic liver disease is associated with adverse one-year post-PCI outcomes in non-diabetic adults, and to characterize the temporal concentration of risk across early (day 0–30) and late (day 31–365) post-procedural periods. Methods Retrospective cohort study using the TriNetX US Collaborative Network (2014–2023). Non-diabetic adults undergoing PCI were stratified by steatotic liver disease (SLD) status (ICD-10-CM K76.0 and/or K75.81). Primary outcome: all-cause mortality (day 1–365). Secondary outcomes: heart failure, MI, 3-point MACE, cardiogenic shock, cardiac arrest, and bleeding. PSM (1:1) balanced demographics, cardiometabolic comorbidities, ACS type, and medications. Outcomes were further assessed across prespecified early and late windows. Results After PSM, 7,434 patients per group were well balanced (SMD < 0.10). All-cause mortality did not differ significantly (2.8% vs. 3.1%; HR, 0.93; 95% CI, 0.77–1.13; p = 0.472). SLD was significantly associated with higher one-year rates of incident heart failure (10.1% vs. 8.9%; HR, 1.15; 95% CI, 1.02–1.30; p = 0.027) and bleeding events (5.1% vs. 3.8%; HR, 1.35; 95% CI, 1.15–1.59; p < 0.001). Time-stratified analysis showed that cardiogenic shock risk was concentrated in the first 30 days (RR, 1.45; p < 0.001) and attenuated to null beyond 30 days and overall. Heart failure excess was similarly early-driven (RR, 1.17; p = 0.005), but the overall one-year signal remained significant (HR, 1.15; p = 0.027), reflecting the sustained contribution of early events. Conclusions Among non-diabetic adults undergoing PCI, coded steatotic liver disease is associated with significantly higher one-year rates of heart failure and bleeding, without a significant mortality difference. Hemodynamic vulnerability is concentrated in the early peri-procedural period, while hemorrhagic risk is sustained. These findings support heightened early surveillance and individualized antithrombotic planning for SLD patients undergoing PCI.