Early sedation with dexmedetomidine in patients with acute myocardial infarction requiring mechanical ventilation

Aims Patients with acute myocardial infarction (AMI) who require invasive mechanical ventilation (IMV) represent a critically ill population with limited data on optimal sedative and analgesic use. Clinical trials assessing dexmedetomidine use exclude poorly represent patients with AMI. This study aimed to compare the use of early sedation with dexmedetomidine with usual care sedation in patients with AMI requiring IMV. Methods and results We utilized the Vizient (R) Clinical Data Base to identify patients aged >= 18 years admitted between 2015 and 2019 with a primary diagnosis of AMI who required IMV. Patients receiving dexmedetomidine on the first day of IMV were included in the early dexmedetomidine group, while 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. We identified 15 928 patients, of which 1620 (10.2%) received early dexmedetomidine. Patients who received early dexmedetomidine were more likely to present with cardiogenic shock (52.0 vs. 47.7%, P = 0.001). In unadjusted analyses, patients receiving early dexmedetomidine had lower in-hospital mortality (33.0 vs. 42.1%) and more ventilator-free days (13.6 vs. 12.1) compared with usual care (both, P < 0.05). After IPTW, patients receiving early dexmedetomidine had an 11.0% [95% confidence interval (CI): 8.6-13.5%] lower mortality and more ventilator-free days (mean difference: +2.2 days, 95% CI: 1.6-2.8 days). Conclusion Early sedation with dexmedetomidine was associated with lower mortality compared with usual care in patients with AMI requiring IMV. A randomized controlled trial of sedative agents in this population is warranted.