Frontiers in cardiovascular medicine · 2026
Prognostic value of combined LDL-C and remnant cholesterol stratification for 24-month major adverse cardiovascular events after primary PCI in patients with STEMI.
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Xie Qianying, Wang Chaoyi, Zhao Wenjing, Cai Lei, Yu Changjie, Pang Liting
Аннотация
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.
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.