Abstract 16861: Early Sedation With Dexmedetomidine in Patients With Acute Myocardial Infarction Who Require Mechanical Ventilation

Abstract

Background: Patients with acute myocardial infarction (AMI) who require mechanical ventilation (MV) are a critically ill population which require sedatives and analgesia for comfort. However, clinical trials, including those for dexmedetomidine, exclude or poorly represent patients with AMI. Research Question: Is early sedation with dexmedetomidine associated with lower hospital mortality compared to usual-care sedation in patients with AMI who require MV? Methods: We utilized the Vizient® Clinical Data Base to identify patients aged ≥18 years who were admitted between 2015 and 2019 with a primary diagnosis of AMI and required MV within 7 days of admission. Patients were assigned to the early dexmedetomidine group if they received dexmedetomidine on the first day of MV; the remaining patients were assigned to the usual care group. Inverse probability of treatment weighting (IPTW) was used to estimate adjusted risk differences between groups. Results: Of the 21,303 patients included in the study, 1,620 (7.6%) received early dexmedetomidine ( Table ). Patients who received early dexmedetomidine were younger (66 vs 67 years) and less likely to be female (29.3% vs 33.8%) (both, P <0.05). Median ventilator days for early dexmedetomidine vs usual care was 4 and 3 days, respectively ( P <0.001). Patients who received early dexmedetomidine had lower hospital mortality compared to usual care (33.0% vs 46.0%, P <0.001) despite higher prevalence of cardiogenic shock. After IPTW, the early dexmedetomidine group had a 16.2% (95% confidence interval [CI]: 13.6%-18.7%) lower mortality. The early dexmedetomidine group had more ventilator-free days (13.6 vs 9.7, P <0.001), which persisted after IPTW (mean difference: +4.9 days, 95% CI: 4.2-5.5 days). Conclusion: Early sedation with dexmedetomidine may be associated with lower mortality compared to usual care in patients with AMI who require MV. A randomized controlled trial of sedative agents in this population is warranted.