The prognostic value of remnant cholesterol in patients with ST segment elevation myocardial infarction

Abstract

Abstract Funding Acknowledgements None. Background Remnant cholesterol (RC) is the cholesterol content within triglyceride rich lipoproteins. It promotes atherosclerotic cardiovascular disease beyond low density lipoprotein cholesterol (LDL-C). Purpose The prognostic role of RC in patients with ST-segment elevation myocardial infarction (STEMI) is unknown. We aimed to estimate RC-related risk beyond LDL-C in patients with STEMI. Methods A total of 6602 consecutive patients with STEMI treated with primary percutaneous coronary intervention (PCI) from 1999 to 2016 were included. RC was calculated as total cholesterol minus LDL-C minus high-density lipoprotein cholesterol. Adjusted Cox models were used to estimate the association between continuous RC levels and all-cause mortality, cardiovascular death, ischemic stroke, and recurrent myocardial infarction (MI) at long-term (median follow-up of 6.0 years). Besides, discordance analyses were applied to examine the risk of the discordantly high RC (RC percentile rank minus LDL-C percentile rank> 10 units) compared to the discordantly low RC (LDL-C percentile rank minus RC percentile rank> 10 units). The concordance was defined as the percentile rank difference between RC and LDL-C ≤ 10 units. Results The median age of patients was 63 years old [interquartile range (IQR) 54–72] and 74.8% of them were men. There were 2441, 1651 and 2510 people in the discordantly low RC group, concordant group and discordantly high RC group. All outcomes in the discordantly high RC group were higher than the other groups and its event rate of all-cause mortality was 31.87 (event number/patient number in the group*100). In the unadjusted analysis, the discordantly high RC was associated with increased all-cause mortality [hazard ratio (HR) 1.82, 95% confidence interval (CI) 1.63–2.04] and increased cardiovascular death (HR 1.79, 95% CI 1.55–2.06) compared to the discordantly low RC. In an adjusted model RC was associated with higher all-cause mortality (HR 1.14, 95% CI 1.07–1.22). The discordantly high RC was associated with increased all-cause mortality (HR 1.55, 95% CI 1.37–1.75) and increased cardiovascular death (HR 1.47, 95% CI 1.25–1.72) compared to the discordantly low RC. There were no associations between RC and ischemic stroke or recurrent MI. Conclusions In patients with STEMI treated with primary PCI, elevated RC levels beyond LDL-C were independently associated with increased all-cause mortality.Graphical summaryLong-term survival probability