The Havoc of Statins: A Case of Statin-Induced Rhabdomyolysis Following Rescue PCI to the Right Coronary Artery.

Abstract

Background: Rhabdomyolysis is a potentially life-threatening condition characterized by skeletal muscle injury leading to the release of intracellular components such as creatine kinase (CK), myoglobin, and electrolytes into the systemic circulation. Statins remain one of the most common pharmacologic causes, particularly when precipitating factors such as high-dose therapy, sepsis, dehydration, or shock coexist. Early recognition and prompt intervention are crucial to avoid complications such as acute kidney injury (AKI), metabolic derangements, and arrhythmias.

Case Presentation: A 56-year-old woman with poorly controlled diabetes and hypertension presented with acute inferior wall myocardial infarction (IWMI). She received fibrinolysis followed by rescue percutaneous coronary intervention (PCI) to the right coronary artery (RCA). Post-procedure, she developed atrial fibrillation, hemodynamic instability, and sepsis, for which she received high-dose statin therapy as part of post-MI management. Within 48 hours, she developed dark urine, rising creatinine, markedly elevated CK levels (6,458 U/L), and declining urine output. Laboratory evaluation confirmed rhabdomyolysis, likely precipitated by statins in the context of sepsis and shock. Statins were discontinued, aggressive IV hydration was initiated, and antibiotics were started for hospital-acquired infection.

Results: Using the McMahon Score, the patient had a high-risk score of 7, indicating a significant likelihood of requiring dialysis. With early recognition, meticulous fluid resuscitation, hemodynamic support, and infection control, her renal function gradually improved without requiring renal replacement therapy. By discharge, her hemodynamics stabilized, urine output normalized, and creatinine levels began trending downward. At the one-week follow-up, renal function had completely recovered, cardiac rhythm normalized, and she remained clinically stable.

Conclusion: This case highlights the importance of recognizing statin-induced rhabdomyolysis in high-risk cardiovascular patients, particularly when interacting factors such as sepsis, dehydration, and hemodynamic compromise coexist. Careful monitoring of renal function and CK levels, early discontinuation of statins, and prompt supportive therapy remain critical to preventing morbidity and facilitating full recovery.