Statin use and 28-day survival in critically ill patients with non-acute myocardial infarction cardiogenic shock: A retrospective cohort study accounting for treatment timing.

Authors

Tonghui Cheng, Panji Wang, Jinxing Ren, Shaoming Ji, Guodong Zhang, Zhengang Liu, Hailong Tao

Published in

Medicine. Volume 105. Issue 38. Pages e50754. Sep 18, 2026.

Abstract

Evidence regarding statin therapy in non-acute myocardial infarction cardiogenic shock is limited, and retrospective medication studies are vulnerable to treatment-timing bias. We examined whether the association between statin exposure and 28-day mortality persisted after accounting for the timing of statin administration. This retrospective cohort study used medical information mart for intensive care IV data from 991 adults with non-acute myocardial infarction cardiogenic shock. Statin exposure was ascertained from medication records that included atorvastatin and other statin agents. In the conventional time-fixed analysis, exposure was defined as receipt of any statin during the intensive care unit (ICU) stay. A 24-hour landmark analysis included patients alive at 24 hours, classified exposure according to statin administration during the 1st 24 hours, and began follow-up at the landmark. Separate 1:1 propensity-score matching (PSM) procedures and Cox models were performed for each exposure definition. Statin agent, 1st recorded dose, route, and time to 1st administration, together with specific mechanical-support, anti-inflammatory, and vasoactive co-treatments, were descriptively summarized in the matched cohorts. In the conventional cohort, 475 patients received a statin during the ICU stay and 516 did not; 255 patients per group remained after PSM. Conventional analyses suggested lower 28-day mortality before matching (adjusted hazard ratio [HR], 0.703; 95% confidence interval [CI], 0.539-0.918; P = .010) and after PSM (adjusted HR, 0.709; 95% CI, 0.507-0.993; P = .045). In the 24-hour landmark cohort, 311 patients received a statin within 24 hours and 680 did not; 255 patients per group remained after PSM. The association was absent before matching (adjusted HR, 1.127; 95% CI, 0.854-1.487; P = .398) and after PSM (adjusted HR, 1.190; 95% CI, 0.833-1.701; P = .339). Atorvastatin was the predominant 1st statin in both matched exposed groups. In 4-category analyses, the apparent benefit among new initiators in conventional models disappeared after the 24-hour landmark definition was applied. The apparent survival advantage associated with conventional time-fixed statin exposure was not reproduced after treatment timing was addressed. These findings do not support an independent 28-day survival benefit from statin administration within the 1st 24 hours of ICU admission and highlight the potential influence of immortal-time, treatment-selection, and co-treatment biases.

PMID:
42760718
Bibliographic data and abstract were imported from PubMed on 19 Sep 2026.

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