Baseline statin therapy and short-term mortality in acute pulmonary embolism: a multicenter cohort study

Background Statins exert anti-inflammatory and antithrombotic effects and have been associated with a reduced incidence of venous thromboembolism. Their impact on outcomes following acute pulmonary embolism (PE), however, remains uncertain. Objective To evaluate the association between baseline statin use and short-term mortality in patients with acute PE. Methods We conducted a retrospective multicenter cohort study of adults with imaging-confirmed PE across National Guard Health Affairs hospitals in Saudi Arabia. Patients were stratified by baseline statin use. The primary outcome was 30-day all-cause mortality. Multivariable logistic regression and propensity score matching were used to account for confounding. Results Statin users were older and had a higher burden of cardiometabolic comorbidities. Thirty-day mortality was numerically higher among statin users (4.2% vs 2.6%). After adjustment, statin use was associated with higher observed mortality (OR 2.16, 95% CI 1.16–3.94), with consistent findings in propensity-matched analysis. However, substantial baseline differences and residual imbalance suggest the presence of confounding by indication. Conclusions Baseline statin use was not associated with improved short-term outcomes following acute PE. The observed association with higher mortality likely reflects underlying comorbidity burden rather than a causal relationship. These findings should be considered hypothesis-generating.