Metabolic dysfunction-associated steatotic liver disease status modifies risks of in-stent restenosis in coronary atherosclerosis: A long-term longitudinal study
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Background
Previous studies have verified that metabolic dysfunction-associated steatotic liver disease (MASLD) confered higher risk of coronary atherosclerosis development. However, whether MASLD influence prognosis after drug-eluting stent (DES) implantation treatment remain not known.
Methods
In this retrospective observational study, 301 included cardiovascular disease (CVD) patients who underwent re-coronary angiography after the first successful DES-based percutaneous coronary intervention. All the patients received computerized tomography (CT) to estimate liver steatosis (65.8% of MASLD). The primary outcome was in-stent restenosis (ISR) determined by intravenous ultrasound. Liver fibrosis was assessed with Fibrosis-4 (FIB-4) index.
Results
After a median follow-up of 27 (range from 12 to 144) months, subjects with MASLD over presented ISR than those without (30.3% vs. 8.7 %, P < 0.001). The Cox proportional hazard model confirmed that, MASLD [HR (95%CI): 2.64 (1.14– 6.11), P = 0.024], FIB-4 index [HR (95%CI): 2.05 (1.50–2.82), P < 0.001] were independently associated with ISR. The hazard model’s area under the receiver operating characteristic curves (AUROC) of 1, 3, 5 and 10 years prediction for ISR were respectively 0.620, 0.801, 0.830 and 0.721. Kaplan-Meier survival analysis demonstrated that ISR increased progressively with the FIB-4 index (log-rank, P<0.001). Additionally, after low-density lipoprotein (LDL) cholesterol reached control standard, FIB-4 index [HR (95%CI): 2.72 (1.43–5.16), P = 0.002] and liver CT attenuation [HR (95%CI): 0.94 (0.88–0.99), P = 0.048] remained independently associated with ISR.
Conclusions
MASLD and related liver fibrosis are associated with the ISR in CVD patients after DES implantation, and management of MASLD might attenuate the risks of ISR.
