Pre-admission statins and circulatory collapse at hospital arrival in ST-segment elevation myocardial infarction

Circulatory collapse at hospital arrival represents one of the most severe clinical presentations of ST-segment elevation myocardial infarction (STEMI) and is associated with poor prognosis. Statins exert pleiotropic effects beyond lipid-lowering, including anti-inflammatory, endothelial, microvascular and plaque-stabilising actions which may influence early clinical severity in myocardial infarction. We investigated the association between pre-admission statin therapy and circulatory collapse at hospital arrival in patients with STEMI undergoing primary percutaneous coronary intervention (PCI).

This retrospective single-centre study included 551 consecutive patients with STEMI undergoing primary PCI. Pre-admission statin therapy was defined as continuous statin use for ≥30 days before admission. The primary outcome was circulatory collapse at hospital arrival, defined using an operational definition of advanced haemodynamic compromise before primary PCI. Multivariable logistic regression and sensitivity analyses including propensity score adjustment and inverse probability of treatment weighting were performed.

Circulatory collapse occurred in 77 patients (14.0%) and was less frequent among patients receiving statins than among those not receiving statins (7.5% vs 16.6%, p=0.005). In the primary multivariable model, pre-admission statin therapy was associated with a lower risk of circulatory collapse (adjusted OR 0.23; 95% CI 0.10 to 0.50; p<0.001). This association remained consistent across sensitivity analyses, including exclusion of lactate-based classification without pre-PCI cardiopulmonary arrest or pharmacological/mechanical circulatory support, propensity score adjustment, inverse probability of treatment weighting and additional adjustment for background preventive medications. 30-day mortality did not differ significantly according to pre-admission statin therapy status.

Pre-admission statin therapy was associated with a lower risk of circulatory collapse at hospital arrival in patients with STEMI undergoing primary PCI. These findings suggest that chronic statin therapy may be associated with a less severe early haemodynamic phenotype at STEMI presentation, although residual confounding cannot be excluded.