What question did this study set out to answer?

The study aims to evaluate how remnant cholesterol levels affect long-term clinical outcomes in CAD patients post-PCI or CABG.

February 6, 2026

Long-term prognostic impact of remnant cholesterol distribution after percutaneous coronary intervention and coronary artery bypass graft: insights from a nationwide cohort

Key Points

The study aims to evaluate how remnant cholesterol levels affect long-term clinical outcomes in CAD patients post-PCI or CABG.
Utilized the Korean National Health Claims database for analysis.
Included 238,040 CAD patients who underwent PCI or CABG from 2011 to 2020.
Calculated remnant cholesterol as total cholesterol minus LDL and HDL cholesterol.
Grouped patients into quartiles based on remnant cholesterol levels.
Monitored the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) over a median follow-up of 5.6 years.
MACCE risk increased significantly with higher remnant cholesterol levels across quartiles.
Q2 showed HR 1.09, Q3 HR 1.14, and Q4 HR 1.21 compared to Q1, indicating a clear gradient of risk.
Combination therapy with statin and ezetimibe was associated with reduced risk in patients with high remnant cholesterol.

Abstract

Abstract Background Increasing evidence indicates that remnant cholesterol (remnant-C) plays a significant role in residual risk among patients with coronary artery disease (CAD). Purpose To assess the distribution of remnant-C in CAD patients who underwent percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) and analyze long-term clinical outcomes based on remnant-C distribution. Methods Our study was based on the Korean National Health Claims database, established by the National Health Insurance Service (NHIS). We analyzed 238,040 CAD patients who underwent PCI or CABG from 2011 to 2020 and had one year of laboratory data. Remnant-C was calculated as total cholesterol minus low-density lipoprotein cholesterol and high-density lipoprotein cholesterol. The primary endpoint was the incidence of major adverse cardiovascular and cerebrovascular events (MACCE), including cardiovascular death, myocardial infarction, repeat revascularization, or non-fatal stroke. Results The study population was grouped into quartiles according to remnant-C levels: Q1 (18 mg/dL; n=62,774), Q2 (18–26 mg/dL; n=63,088), Q3 (26–37 mg/dL; n=56,180), and Q4 (37 mg/dL; n=55,998). The median follow-up duration was 5.6 (3.3–8.4) years. The risk of MACCE gradually increased with remnant-C level, using Q1 as the reference: Q2 (hazard ratio HR 1.09; 95% confidence interval CI 1.06–1.13; p0.001), Q3 (HR 1.14; 95% CI 1.10–1.18; p0.001), and Q4 (HR 1.21; 95% CI 1.16–1.26; p0.001). The cubic spline curve demonstrated a linear correlation between remnant-C levels and MACCE incidence. Among cardiovascular medications, statin with ezetimibe combination therapy was an independent protective factor against high remnant-C (26mg/dL) (Odds ratio 0.93; 95% CI 0.88–0.98). Conclusions High remnant-C levels were associated with an increased risk of MACCE in CAD patients undergoing PCI or CABG. Notably, statin plus ezetimibe combination therapy demonstrated a potential benefit in reducing remnant cholesterol. These findings highlight the importance of targeting remnant-C levels to improve clinical outcomes in CAD patients.

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