BMC Cardiovasc Disord. 2026 Jul 7. doi: 10.1186/s12872-026-06211-y. Online ahead of print.
ABSTRACT
BACKGROUND: Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly recognized as a risk factor for cardiovascular events. However, MASLD's relationship with optical coherence tomography (OCT)-defined coronary plaque vulnerability in patients with acute coronary syndrome (ACS) remains unclear. Moreover, the mediating role of plaque vulnerability in the association between MASLD and major adverse cardiovascular and cerebrovascular events (MACCE) has rarely been investigated. Therefore, this study used OCT to examine the association between MASLD and coronary plaque vulnerability in ACS patients, to assess the impact of MASLD on MACCE, and to explore whether plaque vulnerability mediates this relationship.
METHODS: A total of 820 patients with ACS were enrolled in this study. All patients underwent OCT-guided percutaneous coronary intervention (PCI) and completed abdominal ultrasound (US) or non-contrast computed tomography (CT) examinations. Patients meeting the diagnostic criteria for MASLD were categorized into the MASLD group, while those who did not were assigned to the non-MASLD group.
RESULTS: The MASLD group had a significantly higher prevalence of multivessel disease, more complex coronary artery disease on OCT, and higher detection rates of lipid-rich plaques, cholesterol crystals, and thin-cap fibroatheroma (TCFA). Multivariate analysis confirmed that MASLD was independently associated with these vulnerable plaque features and served as an independent risk factor for major adverse cardiovascular and cerebrovascular events (MACCE) (adjusted hazard ratio [aHR] = 2.05, 95% confidence interval [CI]: 1.34-3.14, P < 0.001). Notably, plaque vulnerability, as represented by cholesterol crystals and TCFA, partially mediated the association between MASLD and MACCE, with mediation proportions of 9.90% and 23.70%, respectively.
CONCLUSION: In patients with ACS, MASLD is associated with more complex coronary artery disease and increased plaque vulnerability assessed by OCT. Furthermore, MASLD is an independent risk factor for MACCE, and this association is partially mediated by plaque vulnerability.
PMID:42414907 | DOI:10.1186/s12872-026-06211-y