Association of metabolic dysfunction-associated steatotic liver disease with coronary plaque vulnerability and prognosis in patients with acute coronary syndrome

Figures

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  Fig. 1. Study flow chart. Abbreviations: ACS, acute coronary syndrome; OCT, optical coherence tomography; PCI, percutaneous coronary intervention; US: ultrasound; CT, computed tomography; MASLD, metabolic dysfunction-associated steatotic liver disease

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  Fig. 2. Typical imaging findings of SLD. A Abdominal US image demonstrating enhanced echogenicity of the liver consistent with SLD (L: liver; K: kidney). B Non-contrast CT image showing the measurement of hepatic and splenic attenuation values in Hounsfield units (HU) using ROIs. Two ROIs were placed in the right hepatic lobe (27.34 HU and 24.14 HU) and one ROI in the spleen (44.66 HU). The L/S ratio was < 1.0, consistent with SLD. Abbreviations: SLD, steatotic liver disease; US, ultrasound; CT, computed tomography; HU, Hounsfield units; ROI, region of interest; L/S, liver-to-spleen ratio

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  Fig. 3. Representative OCT images. A Cholesterol crystals. B Macrophage infiltration. C Microvessels. D TCFA. E Plaque rupture. F Plaque erosion. Abbreviations: OCT, optical coherence tomography; TCFA, thin‑cap fibroatheroma

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  Fig. 4. Pre-procedural OCT quantitative analysis between the non-MASLD and MASLD groups. Abbreviations: OCT, optical coherence tomography; MASLD, metabolic dysfunction-associated steatotic liver disease; MLA, minimal lumen area; FCT, fibrous cap thickness. The results showed that compared with the Non-MASLD group, patients in the MASLD group had longer lesion length, smaller Pre-MLA, greater plaque burden, thinner minimal FCT and a larger maximum lipid angle, whereas plaque volume exhibited no significant intergroup difference

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  Fig. 5. Pre-procedural OCT qualitative analysis between the non-MASLD and MASLD groups. Abbreviations: OCT, optical coherence tomography; MASLD, metabolic dysfunction-associated steatotic liver disease; TCFA, thin-cap fibroatheroma

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  Fig. 6. Post-procedural OCT characteristics between the non-MASLD and MASLD groups. Abbreviations: OCT, optical coherence tomography; MASLD, metabolic dysfunction-associated steatotic liver disease; MLA, minimal lumen area. The results demonstrated that compared with the Non-MASLD cohort, the MASLD group achieved a larger mean stent size and greater total stent length. By contrast, no statistically significant intergroup disparities were detected in post-procedural minimal lumen area (Post-MLA) as well as the stent expansion ratio

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  Fig. 7. Comparison of MACCE between non-MASLD group and MASLD group. Abbreviations: MACCE, major adverse cardiovascular and cerebrovascular events; MASLD, metabolic dysfunction-associated steatotic liver disease; HF or AP, heart failure or angina pectoris

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  Fig. 8. Kaplan-Meier cumulative risk curves of MACCE between MASLD and non-MASLD. Abbreviations: MASLD, metabolic dysfunction-associated steatotic liver disease; MACCE, major adverse cardiovascular and cerebrovascular events; HR, hazard ratio; CI, confidence interval; HF, heart failure; AP, angina pectoris. The results demonstrated that MASLD predicted higher MACCE (HR=2.18, 95%CI 1.53–3.11, log-rank P<0.001), mainly driven by increased rates of unplanned revascularization, HF and AP readmissions. Stroke, cardiovascular mortality and non-fatal MI were comparable between the two groups

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  Fig. 9. Subgroup analyses for MACCE. Adjusted for age, sex, current smoking, hypertension, diabetes mellitus, BMI, WBC, LDL-C, uric acid, and eGFR. Abbreviations: MASLD, metabolic dysfunction-associated steatotic liver disease; MACCE, major adverse cardiovascular and cerebrovascular events; HR, hazard ratio; BMI, body mass index; WBC, white blood cell; LDL-C, low-density lipoprotein cholesterol; eGFR, estimated glomerular filtration rate; STEMI, ST-segment elevation myocardial infarction

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  Fig. 10. Mediating role of OCT plaque characteristics in the association between MASLD and MACCE. A Lipid-rich plaques as mediator; (B) Cholesterol crystals as mediator; (C) TCFA as mediator. Adjusted for age, sex, current smoking, hypertension, diabetes mellitus, BMI, WBC, LDL-C, uric acid, and eGFR. Abbreviations: MASLD, metabolic dysfunction-associated steatotic liver disease; MACCE, major adverse cardiovascular and cerebrovascular events; TCFA, thin-cap fibroatheroma; BMI, body mass index; WBC, white blood cell; LDL-C, low-density lipoprotein cholesterol; eGFR, estimated glomerular filtration rate;