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Effects of elevated remnant cholesterol on outcomes of acute ischemic stroke patients receiving mechanical thrombectomy

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Abstract

Objective: Large cohort studies provided evidence that elevated remnant cholesterol (RC) was an important risk factor for ischemic stroke. However, the association between high RC and clinical outcomes in acute ischemic stroke (AIS) individuals was still undetermined. Methods: This retrospective study enrolled 165 AIS patients undergoing mechanical thrombectomy in one tertiary stroke center. We divided patients into two groups based on the median of their RC levels (0.49 mmol/L). The modified Rankin Scale (mRS) was used to evaluate the primary outcome 90 days after the onset of symptoms. The mRS scores ≤ 2 and ≤ 1 at 90 days were deemed as favorable and excellent outcomes, respectively. Results: In the overall AIS patients undergoing mechanical thrombectomy, there was no obvious distinction between the high and low RC group at 90-day favorable outcome (41.0% vs. 47.1%, P = 0.431) or excellent outcome (23.1% vs. 31.0%, P = 0.252). In the subgroup analysis stratified by stroke etiology, non-large artery atherosclerosis (non-LAA) stroke patients yielded with less favorable or excellent prognosis in the high RC group (26.8% vs. 46.8%, adjusted OR = 0.31, 95%CI: 0.11–0.85, P = 0.023; or 12.2% vs. 29.0%, adjusted OR = 0.18, 95%CI: 0.04–0.80, P = 0.024, respectively.). Post hoc power analyses indicated that the power was sufficient for favorable outcome (80.38%) and excellent outcome (88.72%) in non-LAA stroke patients. Additionally, RC can enhance the risk prediction value of a poor outcome (mRS scores 3–6) based on traditional risk indicators (including age, initial NIHSS score, operative duration, and neutrophil-to-lymphocyte ratio) for non-LAA stroke patients (AUC = 0.86, 95%CI: 0.79–0.94, P < 0.001). Conclusion: In AIS patients undergoing mechanical thrombectomy, elevated RC was independently related to poor outcome for non-LAA stroke patients, but not to short-term prognosis of LAA stroke patients.

Highlights

The levels of RC in LAA stroke patients were greater than that in non-LAA stroke patients.

High RC was independently associated with poor outcomes of non-LAA stroke patients after mechanical thrombectomy.

High RC was a new predictor for poor outcomes of non-LAA stroke patients after mechanical thrombectomy.

High RC was not related to short-term prognosis of LAA stroke patients after mechanical thrombectomy.

The study suggested that we should not only pay attention to the effects of dyslipidemia on LAA stroke, but also attach importance to the influence of hyperlipidemia in the prevention and therapy of non-LAA stroke.

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All data generated or analyzed during this study are included in this article. Further enquiries can be directed to the corresponding author.

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Funding

This work was supported by grants from the Institutional Foundation of The First Affiliated Hospital of Xi’an Jiaotong University (2022MS-32) and Natural Science Foundation of Shaanxi Province (2022JQ-987).

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Authors and Affiliations

  1. Stroke Centre, Department of Neurology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China

    Mengmeng Li, Yixin Zhao, Wanying Chen, Xiangyu Lei, Xiaoyu Wu, Jiaxin Han, Lei Lei, Qingfan Wang, Guogang Luo & Meng Wei

  2. Department of Neurology, Xi’an Children’s Hospital, Xi’an, China

    Meng Wang

  3. Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China

    Rui Zhong

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ML, MW and GL conceived, designed, and drafted the manuscript. MW, RZ, YZ, WC, XL, XW, JH, LL, and QW collected the data and edited the figures. All authors revised the article and approved the submitted version.

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Li, M., Wang, M., Zhao, Y. et al. Effects of elevated remnant cholesterol on outcomes of acute ischemic stroke patients receiving mechanical thrombectomy. J Thromb Thrombolysis 57, 390–401 (2024). https://doi.org/10.1007/s11239-023-02939-y

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