Impact of remnant cholesterol on cardiovascular outcomes in non-myocardial infarction patients undergoing percutaneous coronary intervention

AIM: Remnant cholesterol (RC) as the cholesterol content of remnant lipoproteins has been associated with cardiovascular outcomes. However, studies investigating the impact of RC in stable patients undergoing percutaneous coronary intervention (PCI) are scarce. The present study aimed to evaluate the impact of RC on outcomes in patients undergoing PCI for a non-myocardial infarction (MI). METHODS: Patients undergoing PCI from 2012 to 2023 at a tertiary center were analyzed. Subgroups according to calculated RC percentiles (<50th[reference], 50th to <75th, 75th to <90th, ≥90th) were created. The primary outcome of interest was a composite major adverse cardiovascular event (MACE) endpoint, including all-cause mortality, spontaneous myocardial infarction and stroke one year after PCI. RESULTS: Overall, 19,289 patients were included in the current analysis. Patients in higher RC percentiles were younger, less often white, had a higher BMI, and had more comorbidities. Rates for the composite MACE endpoint did not differ significantly according to RC concentrations. However, a significantly increased risk for incident MI in the highest RC percentile subgroup (≥90th percentile - adjusted hazard ratio: 1.54, 95% Confidence Interval: 1.07-2.22; trend p-value=0.010) in comparison to the <50th percentile was noted. CONCLUSIONS: While RC did not associate with the composite MACE endpoint, higher concentrations of this subtype of triglyceride-rich lipoproteins was a marker for incident ischemic endpoints such as MI in patients undergoing PCI for a non-MI.