Association of Statin Use With Short- and Long-Term Mortality in Critically Ill Patients With Aortic Stenosis: A Retrospective Cohort Study

Vollständiger Abstract

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Background Statins have not been shown to modify valvular disease progression in relatively stable aortic stenosis populations, but their prognostic relevance during critical illness remains unclear. Methods We conducted a retrospective cohort study using the MIMIC-IV database. Adult patients with aortic stenosis were included at their first ICU stay if the ICU length of stay was at least 24 h. In-hospital statin prescription exposure was identified from prescription records. The primary outcome was 30-day all-cause mortality after ICU admission, with secondary outcomes at 7, 60, 120, and 365 days. Associations were assessed using hierarchical Cox regression models and propensity score matching (1:1 nearest-neighbor matching; caliper 0.03). Multiple imputation was applied for variables with less than 30% missingness. A 24-h landmark sensitivity analysis was additionally performed for the 30-day primary endpoint. Results A total of 1484 patients were included, of whom 1030 had statin prescription exposure and 454 did not; propensity score matching yielded 706 patients. In the fully adjusted primary model, statin exposure was associated with lower 30-day mortality (hazard ratio [HR] 0.458, 95% CI 0.312-0.674; P < 0.0001). In the matched cohort, statin use remained associated with lower 30-day mortality (HR 0.424, 95% CI 0.269-0.666; P < 0.001). Results The results were materially unchanged in the 24-h landmark sensitivity analysis (HR 0.434, 95% CI 0.288-0.653; P < 0.0001). E-values ranged from 2.80 to 5.91. Conclusions In this retrospective ICU cohort of patients with aortic stenosis, in-hospital statin prescription exposure was associated with lower all-cause mortality across evaluated follow-up time points. Prospective studies that better account for treatment selection and time-varying exposure are warranted.