METHODS: Utilizing the Vizient® Clinical Data Base, we identified patients ≥18 years admitted from 2015 to 2019 with a primary diagnosis of AMI and requiring invasive
mechanical ventilation (IMV). We assessed for the incidence of patients undergoing
tracheostomy, outcomes stratified by the timing of
tracheostomy (≤10 vs >10 days), and the association between dual antiplatelet
therapy (
DAPT) use and in-hospital mortality.
RESULTS: We identified 26 435 patients presenting with AMI requiring IMV. The mean (SD) age was 66.8 (12.3) years and 33.4% were women. The incidence of
tracheostomy was 6.0% (n = 1573), and the median IMV time to
tracheostomy was 12 days, 55.6% of which underwent percutaneous and 44.4% underwent open
tracheostomy. Over 90% (n = 1424) underwent
tracheostomy (>10 days) and had a similar mortality when compared to early (≤10 days)
tracheostomy (22.5% vs 22.8%, P = 0.94). On the day of
tracheostomy, only 24.7% were given
DAPT, which was associated with a lower mortality than those not on
DAPT (17.4% vs 23.7%, P = 0.01). After multivariable adjustment,
DAPT use on the day of
tracheostomy remained associated with lower in-hospital mortality (odds ratio 0.68; 95% confidence interval: 0.49-0.94, P = 0.02).
Tracheostomy complications were not different between groups (P > 0.05), but more patients in the
DAPT group required post-
tracheostomy blood transfusions (5.6% vs 2.7%, P = 0.01).
CONCLUSION: Approximately 1 in 20 intubated AMI patients requires
tracheostomy. The lack of
DAPT interruption on the day of
tracheostomy but not the timing of
tracheostomy was associated with a lower in-hospital mortality. Our results suggest that
DAPT should not be a barrier to
tracheostomy for patients with AMI.