Residual risk profiles of inflammation and cholesterol predict postoperative kidney injury and long-term mortality in patients undergoing coronary artery bypass grafting (CABG). The findings were presented at the European Society of Cardiology Congress 2025.

Acute kidney injury is a common complication after CABG and contributes to increased mortality. This study analyzed 35,788 consecutive patients from 2013 to 2022, categorizing them by remnant cholesterol and hypersensitive C-reactive protein levels into no residual risk, residual inflammatory risk (RIR), residual cholesterol risk (RCR), and combined residual risk (RCIR).

Patients with RIR had a 14% higher risk of any AKI (OR 1.14, 95% CI 1.08–1.21) and a 61% higher risk of severe AKI (KDIGO stages 2/3, OR 1.61, 95% CI 1.41–1.84). Residual cholesterol risk was associated with severe AKI mainly in patients with diabetes (OR 1.39, 95% CI 1.04–1.83). The combination of both residual risks further increased severe AKI, particularly in diabetic patients (OR 1.90, 95% CI 1.38–2.56). Five-year mortality was 34% higher in patients with RIR (HR 1.34, 95% CI 1.19–1.52).

Perioperative statin therapy had differential effects: it increased severe AKI risk in patients without residual risk (OR 1.27, 95% CI 1.04–1.53) but reduced risk in those with residual cholesterol risk (OR 0.58, 95% CI 0.34–0.96).
These results suggest that assessing residual risk profiles before CABG can guide personalized statin therapy and improve kidney outcomes, particularly in patients with inflammation and diabetes, while potentially reducing long-term mortality.