Features of myocardial infarction with ST segment elevation in patients with non-alcoholic liver steatosis and steatohepatitis

Aim

To evaluate the features of ST-segment elevation myocardial infarction (STEMI) in patients with two types of metabolic-associated fatty liver disease (MAFLD), that is, liver steatosis (LS) and steatohepatitis (SH).

Material and methods

We enrolled 71 patients with STEMI and MAFLD (median age 62.9 [59.9;66.0] years) who underwent primary coronary angiography and percutaneous coronary intervention (PCI). Liver stiffness was measured by elastometry. We also evaluated cardiospecific troponin I upon admission (cTnI-1) and at 24 hours (cTnI-24), mean platelet volume (MPV), transaminases and gamma-glutamyltransferase (GGT) activity and concentration of cytokeratin-18 fragments (CKF-18).

Results

LS and SH were diagnosed in 27 and 44 patients, respectively. STEMI in patients with SH was characterized by higher thrombotic load (TIMI trombus grade 3, p=0.001), cTnI-1, cTnI-24, transaminases and GGT levels, MPV, impaired normalization of ST elevation after primary PCI and more frequently required the two-stage PCI (p=0.021). SH was associated with increased risk of coronary events within 18 months after acute coronary syndrome (OR 8.52: 95% CI 5.77-11.04) compared to LS. The inclusion of CKF-18 level in the multidimensional model improved the accuracy of the initial model for predicting coronary events in patients with STEMI and MAFLD (increase in the area under the ROC curve from 69.3 to 89.9, p = 0.0007).

Conclusion

STEMI in patients with SH is associated with a higher thrombotic load, more extensive myocardial necrosis and worse prognosis within 18 months after acute coronary syndrome.

Key words

Metabolic-associated fatty liver disease, myocardial infarction, steatohepatitis, liver fibroelastometry, cytokeratin-18 fragments