Prognostic Impact of Remnant-like Particle Cholesterol in Patients with Differing Glucose Metabolic Status: an Observational Cohort Study from China

Background: It is uncertain whether remnant-like particle cholesterol (RLP-C) could predict residual risk in patients under different glucose metabolic status. This study aimed to evaluate the relationship between RLP-C and adverse prognosis in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) undergoing percutaneous coronary intervention (PCI) and identify the potential impact of glucose metabolism on the predictive value of RLP-C.Methods: The study enrolled 2419 patients with NSTE-ACS who underwent PCI at Beijing Anzhen Hospital from January to December 2015. RLP-C was calculated as follows: total cholesterol (TC) minus low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). The primary endpoint was a composite of events as follows: all-cause death, non-fatal myocardial infarction (MI), and ischemia-driven revascularization.Results: RLP-C was significantly associated with adverse prognosis in the total population [hazard ratio (HR) 1.291 per 1-SD increase of RLP-C, 95% confidence interval (CI) 1.119-1.490, P < 0.001], independent of confounding risk factors. However, subgroup analysis showed that increasing RLP-C was shown to be associated with a higher risk of adverse events in the diabetic population only [HR 1.385 per 1-SD increase of RLP-C, 95% CI 1.183-1.620, P < 0.001]. RLP-C failed to be a significant determinant of adverse prognosis in the pre-diabetic and non-diabetic population. The addition of RLP-C to the baseline model significantly enhanced the predictive value for adverse events both in the total and diabetic populations.Conclusions: Higher RLP-C level is a significant and independent predictor of adverse prognosis in diabetic patients with NSTE-ACS who underwent PCI.