Prognostic outcomes of masld and obesity in acute myocardial infarction

Abstract Background Patients with obesity and metabolic dysfunction-associated steatotic liver disease (MASLD) have an increased risk of cardiovascular disease. This study seeks to examine the prognostic significance of obesity and MASLD in patients presenting with acute myocardial infarction (AMI). Methods This study compared the clinical characteristics and outcome of patients with and without obesity and MASLD at a tertiary centre in Singapore. Patients were stratified by their obesity and MASLD statuses into four groups. Obesity was defined as BMI ≥27.5. MASLD was defined as hepatic steatosis, which was determined using Hepatic Steatosis Index, and at least one of the five metabolic criteria. Cox regression analysis was used to investigate independent predictors of long-term all-cause mortality, adjusted for age, sex, ethnicity, previous AMI, AMI type, and left ventricular ejection fraction. Results A total of 5702 patients with AMI were included in this study. Among the cohort, 3803 were non-obese and without MASLD, 343 were non-obese with MASLD, 638 were obese without MASLD, and 918 were obese with MASLD. The mean follow-up duration was 3.1 ± 2.4 years. Non-obese patients with MASLD were most likely to develop complications of heart failure, cardiogenic shock, and stroke. On 30-day follow-up, there were no significant differences in all-cause mortality (p=0.312). However, on long-term follow-up, non-obese MASLD patients had the highest mortality (9.6%, p=0.019). After adjusting for confounders, patients who were non-obese with MASLD, and patients who were obese with MASLD, remained independently associated with higher long-term all-cause mortality (HR 1.400, 95% CI 1.077-1.820 and HR 1.222, 95% CI 1.005-1.485 respectively), with non-obese patients without MASLD as the reference. Conclusions This study demonstrates that regardless of obesity status, patients with MASLD have poorer outcomes in AMI. With its high metabolic burden, it is important to identify patients with MASLD for risk stratification and targeted treatment.Adjusted long-term all-cause mortality