Calculated remnant cholesterol and 7-day severe adverse events after carotid revascularization: A retrospective cohort study.

BACKGROUND AND AIM: Remnant cholesterol (RC), calculated from routine lipid measurements, has been associated with atherosclerotic vascular disease, but its relationship with early severe adverse events (SAEs) after carotid revascularization remains uncertain. We examined the association between calculated preoperative RC and 7-day SAE after carotid endarterectomy or carotid artery stenting. METHODS AND RESULTS: This single-center retrospective cohort included 3361 consecutive patients undergoing carotid revascularization between January 2017 and July 2023. RC was calculated as total cholesterol minus low-density lipoprotein cholesterol minus high-density lipoprotein cholesterol. The primary outcome was a composite of ischemic stroke, hemorrhagic stroke, myocardial infarction, seizure, unplanned reoperation, or death within 7 days. Multivariable logistic regression modeled RC per 10-mg/dL increase. Seventy patients (2.1%) experienced a 7-day SAE. Each 10-mg/dL increase in RC was associated with higher adjusted odds of 7-day SAE (adjusted odds ratio, 1.325; 95% confidence interval, 1.206-1.456; P < 0.001). The association was consistent across prespecified RC-outlier, sparse-event, and adjustment-set sensitivity analyses. Restricted cubic spline analysis supported an overall association, although apparent nonlinearity was concentrated in the sparse upper tail and attenuated after outlier handling. In exploratory component analysis, the association was most evident for ischemic stroke. CONCLUSIONS: Higher calculated preoperative RC was associated with higher adjusted odds of 7-day SAE after carotid revascularization. RC may provide complementary lipid-related information for perioperative assessment, but external validation is required before clinical implementation.