Statin Use After Acute Myocardial Infarction in Patients on Dialysis: Associations with All-Cause Mortality

Background: Statin therapy is standard for secondary cardiovascular prevention but its role in end-stage renal disease (ESRD) patients on dialysis remains unclear. Despite guideline caution, statins are often prescribed post-acute myocardial infarction (AMI) in this population. We evaluated the impact of post-AMI statin use on mortality and adverse outcomes in dialysis-dependent patients using global real-world data. Methods: We used the TriNetX global electronic health record network to identify adults with ESRD who developed AMI at least 3 months after initiating dialysis. Patients with malignancy were excluded. We compared statin users (initiated within 1 month of AMI; n=21,358) to non-users (n=14,160). Patients who died within the first 3 months post-AMI were excluded from the analysis. After 1:1 propensity score matching, 10,379 patients remained in each group. The primary outcome was all-cause mortality assessed between 3 months and 10 years post-AMI. Survival analyses were performed using Kaplan–Meier estimates and multivariable Cox proportional hazards regression over this follow-up period. Results: In the Kaplan–Meier survival analysis of statin users after propensity score matching, a significantly higher risk of all-cause mortality was observed compared to non-statin users (HR: 1.151, 95% CI: 1.096–1.209, p < 0.001). 10-year survival was significantly lower in statin users (28.4%) vs. non-users (33.3%; log-rank p<0.001). In the multivariable Cox proportional hazards model, after adjusting for potential confounders—including age, sex, race, ethnicity, comorbidities, concurrent medications, and laboratory parameters—the increased risk remained statistically significant (HR: 1.128, 95% CI: 1.076–1.182, p < 0.001). Conclusion: In this global, real-world analysis of dialysis-dependent patients with AMI, post-event statin use was associated with a significantly increased risk of all-cause mortality over a 10-year follow-up period, even after rigorous propensity score matching and multivariable adjustment. These findings challenge the generalized application of statin therapy in the dialysis population and underscore the need for individualized risk-benefit assessment. Further prospective research is needed to clarify the role of statins in this population.