AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Pre-Admission Statin Therapy and Circulatory Collapse at Hospital Arrival in ST-Segment Elevation Myocardial Infarction
By Morikawa S, Kato H, Takahashi N et al.
Background: Circulatory collapse at hospital arrival is a severe presentation of ST-segment elevation myocardial infarction (STEMI). Statins have pleiotropic effects beyond lipid lowering that may influence early clinical severity. We evaluated the association between pre-admission statin therapy and circulatory collapse at hospital arrival in patients undergoing primary percutaneous coronary intervention (PCI). Methods: We retrospectively studied 551 patients with STEMI undergoing primary PCI at a tertiary cardiovascular center from 2019 to 2026. Pre-admission statin therapy was defined as continuous statin use for at least 30 days before admission. The primary outcome was circulatory collapse, defined as advanced-stage hemodynamic compromise broadly consistent with Society for Cardiovascular Angiography and Interventions shock stage C or higher, including persistent hypotension, vasopressor/inotrope use, mechanical circulatory support, or lactate 4.0 mmol/L or higher with hypoperfusion before primary PCI. Multivariable logistic regression adjusted for age, sex, prior coronary artery disease, symptom-to-arrival time, estimated glomerular filtration rate, and renin-angiotensin-aldosterone system inhibitor use. Sensitivity analyses included complete-case analysis, exclusion of pre-procedural cardiopulmonary arrest, propensity score adjustment, inverse probability of treatment weighting, and a stricter endpoint excluding lactate-based classification without pharmacologic or mechanical circulatory support. Results: Pre-admission statins were used in 160 patients (29.0%). Circulatory collapse occurred in 77 patients (14.0%) and was less frequent among statin users than non-users (7.5% vs 16.6%; P=0.005). In the primary multivariable model, pre-admission statin therapy was associated with lower odds of circulatory collapse (adjusted odds ratio 0.23; 95% confidence interval 0.10-0.50; P less than 0.001). This association was directionally consistent across prespecified subgroups and remained consistent in propensity score-adjusted analysis (adjusted odds ratio 0.27; 95% confidence interval 0.12-0.56; P=0.001), inverse probability of treatment weighting analysis (odds ratio 0.35; 95% confidence interval 0.14-0.90; P=0.030), and stricter endpoint analysis (adjusted odds ratio 0.25; 95% confidence interval 0.11-0.57; P=0.001). Thirty-day mortality did not differ significantly by statin status. Conclusions: 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 hemodynamic phenotype, although residual confounding cannot be excluded.