Remnant cholesterol associated with contrast-induced acute kidney injury in patients with ST-segment elevation myocardial infarction following percutaneous coronary intervention

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Abstract
Remnant cholesterol (RC) serves as an important indicator for assessing atherosclerotic cardiovascular disease, however, correlation with contrast-induced acute kidney injury (CI-AKI) remains unclear. This research investigated the relationship between RC and the occurrence of CI-AKI in STEMI patients following percutaneous coronary intervention (PCI). A cohort of 1288 patients with STEMI undergoing PCI were enrolled and stratified into CI-AKI and non-CI-AKI groups based on standard diagnostic criteria. Independent risk factors for CI-AKI were identified using Boruta analysis and logistic regression. The association between RC and CI-AKI was evaluated for nonlinearity using restricted cubic splines (RCS). The predictive performance of RC for identifying CI-AKI was assessed using the receiver operating characteristic (ROC) curve, while its incremental value to an existing risk model was determined by the net reclassification index (NRI) and integrated discrimination index (IDI). The ROC analysis showed that the area under the curve (AUC) for predicting CI-AKI based on blood urea nitrogen, left ventricular ejection fraction, and fasting plasma glucose was 0.739 (95% CI 0.703–0.775, P < 0.001), while the AUC increased to 0.803 (95% CI 0.772–0.834, P < 0.001) when RC was integrated into the model. Additionally, the NRI (0.618, 95% CI 0.470–0.766, P < 0.001) and the IDI (0.053, 95% CI 0.036–0.076, P < 0.001) both highlight improved prediction performance. RC is an independent predictor of CI-AKI in patients with STEMI undergoing PCI. The inclusion of RC significantly enhances the predictive accuracy of a model based on established clinical parameters.

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