Abstract Background Fatty liver caused by nutritional metabolic disorders regardless of other chronic liver diseases has been proposed as a new liver disease concept, metabolic dysfunction-associated fatty liver disease (MAFLD). With the alteration from non-alcoholic fatty liver disease to MAFLD, MAFLD can be recognized as higher CVD risk. However, the association of MAFLD with adverse coronary CT angiography (CCTA) findings, such as the presence of obstructive and high-risk plaque, and cardiovascular events has not been fully elucidated. Purpose This study was aimed to investigate additional risk stratification benefits of MAFLD diagnosed by hepatic steatosis assessed during CCTA in patients with suspected coronary artery disease (CAD). Methods A total of 2289 patients without a history of CAD who underwent CCTA in our institute from August 2011 and December 2016 were enrolled. Hepatic steatosis, defined on CT as a hepatic-to-spleen attenuation ratio of <1.0, was examined just before the evaluation of CCTA. Adverse CCTA findings were defined as obstructive and/or high-risk plaque. The major adverse cardiovascular events (MACE) were composite coronary events including cardiovascular death, acute coronary syndrome, and late coronary revascularization. The incremental predictive value of MAFLD was evaluated using the global chi-square values and C-statistic. Results Among 2289 patients (60% men, mean age 68 years), MAFLD was identified in 382 (17%) patients. The presence of adverse CCTA findings in patients with MAFLD was significantly greater than that in patients without MAFLD (40% and 35%, p=0.039). During a median follow-up of 4.4 years, 103 (4.4%) MACE were observed. In the multivariate Cox regression analysis, MAFLD was significantly associated with MACE in a model included traditional risk factors and adverse CCTA findings (HR 1.73, 95%CI 1.10–2.72, P = 0.017). The Kaplan–Meier analysis showed that patients with both MAFLD and adverse CCTA findings had highest event rates compared with patients without MAFLD or adverse CTA findings (log rank test, p=0.004). By adding MAFLD to a prediction model including adverse CCTA findings, the global chi-square values and C-statistic significantly increased from 80.6 to 86.2 (P = 0.017) and 0.72 to 0.74 (P = 0.044), respectively. Conclusions MAFLD concurrently assessed during CCTA enables more accurate detection of patients at higher risk of MACE In patients with suspected stable CAD.