What is the clinical evidence from this study?

Study design: Cohort. Population: Suspected stable coronary artery disease (n=1148). Intervention: Hepatic steatosis vs. Absence of hepatic steatosis. Primary outcome: Major adverse cardiac events (MACE), a composite of cardiac death, acute coronary syndrome, and late revascularization (HR 4.01, 95% CI 2.12-7.59, p=<0.001).

What does this research mean for the field?

Hepatic steatosis concurrently assessed during coronary computed tomography angiography independently predicts an increased risk of major adverse cardiac events and provides incremental prognostic value beyond traditional risk scores and CTA findings. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

June 26, 2021European Journal of Preventive CardiologyOpen Access

Incremental prognostic value of non-alcoholic fatty liver disease over coronary computed tomography angiography findings in patients with suspected coronary artery disease

Q: What are the key findings of this study?

Hepatic steatosis concurrently assessed during coronary CTA was independently associated with a significantly increased risk of major adverse cardiac events (HR 4.01) in patients with suspected stable CAD.

Q: What does this research mean for the field?

Hepatic steatosis concurrently assessed during coronary computed tomography angiography independently predicts an increased risk of major adverse cardiac events and provides incremental prognostic value beyond traditional risk scores and CTA findings. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

Hepatic steatosis on coronary CTA is linked to ~300% higher MACE risk in suspected stable CAD.

HR 4.01
95% CI 2.12-7.59
P<0.001
n=1,148

Why the study?

The study aimed to evaluate whether concurrent assessment of hepatic steatosis during coronary CTA provides additional risk stratification in patients with suspected stable CAD.

Does concurrent assessment of hepatic steatosis during coronary CTA improve risk stratification for MACE in outpatients with suspected stable CAD?

Population

1148 Japanese outpatients without CAD history undergoing coronary CTA for suspected stable CAD

Comparison

Presence vs absence of hepatic steatosis

Design

Prospective study

Follow-up

Median 3.9 years

Authors

KIKeishi IchikawaOkayama University TMToru MiyoshiOkayama University KOKazuhiro OsawaKawasaki Medical School

Discussion

Member takes

Implication

Concurrent evaluation of hepatic steatosis during coronary CTA provides incremental prognostic value for MACE over standard CTA findings and clinical risk scores in patients with suspected stable CAD.

Study Design

Type

Cohort (n=1,148)

Blinding

Outcome assessors blinded

Multicenter

Structured PICO

Does concurrent assessment of hepatic steatosis during coronary CTA improve risk stratification for MACE in outpatients with suspected stable CAD?

Population

1,148 Japanese outpatients (mean age 64, 45% female) without a history of CAD who underwent coronary CTA for suspected stable CAD, followed for a median of 3.9 years.

Exposure

Concurrent assessment of hepatic steatosis (HS) during coronary CTA (defined as hepatic-to-spleen attenuation ratio <1.0).

Comparator

Standard risk assessment using Framingham risk score and adverse CTA findings (obstructive and/or high-risk plaque) without HS assessment.

Outcome

Major adverse cardiac events (MACE), a composite of cardiac death, acute coronary syndrome, and late revascularization.composite

Main Result

Hazard Ratio: 4.01 (95% CI 2.12–7.59)

Absolute Event Rate: 9.3% vs 1.9%

p-value: p=<0.001

Limitations

Single-centre study
Study population comprised solely of Japanese patients
Information on acute coronary syndrome culprit lesions was not available
Hepatic steatosis was diagnosed via CT without histological confirmation
Did not obtain information about inflammatory markers, change in medication, diet, physical activity, and risk factor control during follow-up

Cite This Study

Ichikawa et al. (2021) conducted a cohort in Suspected stable coronary artery disease (n=1,148). Hepatic steatosis vs. Absence of hepatic steatosis was evaluated on Major adverse cardiac events (MACE), a composite of cardiac death, acute coronary syndrome, and late revascularization (HR 4.01, 95% CI 2.12-7.59, p=<0.001). Hepatic steatosis concurrently assessed during coronary CTA was independently associated with a significantly increased risk of major adverse cardiac events (HR 4.01) in patients with suspected stable CAD.

synapsesocial.com/papers/6aa8c1d0ca0dde3763da7642 https://doi.org/10.1093/eurjpc/zwab120

Topics

Coronary artery disease Coronary CT angiography

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Incremental prognostic value of non-alcoholic fatty liver disease over coronary computed tomography angiography findings in patients with suspected coronary artery disease

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Incremental prognostic value of non-alcoholic fatty liver disease over coronary computed tomography angiography findings in patients with suspected coronary artery disease

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider