Hepatic steatosis and advanced hepatic fibrosis are independent predictors of long‐term mortality in acute myocardial infarction

• Published in: Diabetes, obesity & metabolism Vol. 25; no. 4; pp. 1032 - 1044
• Main Authors: Chin, YipHan, Lim, Jieyu, Kong, Gwyneth, Ng, Cheng Han, Goh, Rachel, Muthiah, Mark, Mehta, Anurag, Chong, Bryan, Lin, Chaoxing, Chan, Kai En, Kong, William, Poh, Kian Keong, Foo, Roger, Chai, Ping, Yeo, Tiong‐Cheng, Low, Adrian F., Lee, Chi Hang, Tan, Huay Cheem, Chan, Mark Yan‐Yee, Richards, A Mark, Loh, Poay‐Huan, Chew, Nicholas W. S.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.04.2023; Wiley Subscription Services, Inc
• Subjects: acute myocardial infarction; advanced hepatic fibrosis; Body mass index; Diabetes mellitus; Fatty Liver; Female; Fibrosis; Heart attacks; hepatic steatosis; Humans; Hyperlipidemia; Liver Cirrhosis; Liver diseases; Medical prognosis; Mortality; Myocardial Infarction; Prognosis; prognostic outcomes; Regression analysis; Risk Factors; Steatosis; advanced hepatic fibrosis; acute myocardial infarction; prognostic outcomes; hepatic steatosis
• ISSN: 1462-8902; 1463-1326; 1463-1326
• DOI: 10.1111/dom.14950

Aim To examine the prevalence and prognosis of hepatic steatosis and fibrosis in post‐acute myocardial infarction (AMI) patients. Methods Patients presenting with AMI to a tertiary hospital were examined from 2014 to 2021. Hepatic steatosis and advanced hepatic fibrosis were determined using the Hepatic Steatosis Index and fibrosis‐4 index, respectively. The primary outcome was all‐cause mortality. Cox regression models identified determinants of mortality after adjustments and Kaplan–Meier curves were constructed for all‐cause mortality, stratified by hepatic steatosis and advanced fibrosis. Results Of 5765 patients included, 24.8% had hepatic steatosis, of whom 41.7% were diagnosed with advanced fibrosis. The median follow‐up duration was 2.7 years. Patients with hepatic steatosis tended to be younger, female, with elevated body mass index and an increased metabolic burden of diabetes, hypertension and hyperlipidaemia. Patients with hepatic steatosis (24.6% vs. 20.9% mortality, P < .001) and advanced fibrosis (45.6% vs. 32.9% mortality, P < .001) had higher all‐cause mortality rates compared with their respective counterparts. Hepatic steatosis (adjusted hazard ratio 1.364, 95% CI 1.145‐1.625, P = .001) was associated with all‐cause mortality after adjustment for confounders. Survival curves showed excess mortality in patients with hepatic steatosis compared with those without (P = .002). Conclusions Hepatic steatosis and advanced fibrosis have a substantial prevalence among patients with AMI. Both are associated with mortality, with an incrementally higher risk when advanced fibrosis ensues. Hepatic steatosis and fibrosis could help risk stratification of AMI patients beyond conventional risk factors.