Key result
Elevated LDL-C plus remnant cholesterol linked to ~154% higher 24-month MACE risk post-PCI.
Why the study?
The prognostic value of combined LDL-C and remnant cholesterol stratification in STEMI patients after primary PCI was unclear.
Does combined LDL-C and remnant cholesterol stratification predict 24-month major adverse cardiovascular events in STEMI patients after primary PCI?
Cohort (n=812)
No
Does combined LDL-C and remnant cholesterol stratification predict 24-month major adverse cardiovascular events in STEMI patients after primary PCI?
Hazard Ratio: 2.535 (95% CI 1.591–4.041)
Absolute Event Rate: 28.4% vs 12.4%
p-value: p=<0.001
Combined LDL-C and remnant cholesterol stratification at 1 month post-PCI improves risk prediction for 24-month MACE in STEMI patients, with elevated remnant cholesterol driving residual risk.
May aid post-PCI STEMI risk stratification; leaves open whether RC-targeted therapy improves outcomes.
Objective This single-center prospective observational cohort study aimed to investigate the prognostic value of combined low-density lipoprotein cholesterol (LDL-C) and remnant cholesterol (RC) stratification in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods A total of 812 STEMI patients were enrolled and stratified into four groups according to LDL-C and RC levels measured at 1-month post-PCI. The primary endpoint was 24-month major adverse cardiovascular events (MACE). Results The overall MACE rate increased stepwise across the four subgroups ( P < 0.001). Multivariate Cox regression showed that elevated RC was independently associated with MACE (HR = 1.559, 95% CI: 1.018−2.386, P = 0.041), whereas isolated high LDL-C was not (HR = 1.329, 95% CI: 0.992−1.781, P = 0.057). Compared with the low LDL-C + low RC group, the high LDL-C + high RC group carried the highest MACE risk (HR = 2.535, 95% CI: 1.591–4.041, P < 0.001), followed by the low LDL-C + high RC group (HR = 1.874, 95% CI: 1.153–3.045, P = 0.011). Conclusions Combined LDL-C and RC stratification may assist risk evaluation in STEMI patients after primary PCI. Elevated RC, rather than isolated high LDL-C, is associated with adverse outcomes, which may help identify patients with residual lipid-related risk.
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Xie et al. (2026) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=812). Combined high LDL-C and high remnant cholesterol (RC) vs. Low LDL-C and low remnant cholesterol (RC) was evaluated on 24-month major adverse cardiovascular events (MACE) (HR 2.535, 95% CI 1.591-4.041, p=<0.001). Concurrent elevation of LDL-C and remnant cholesterol was associated with a significantly increased risk of 24-month major adverse cardiovascular events compared to low levels of both lipids (HR 2.535).
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