Association of dexmedetomidine use with stroke-heart syndrome in critically ill patients with ischemic stroke: a MIMIC-IV study

Background Stroke-heart syndrome (SHS) is associated with poor outcomes after ischemic stroke (IS), but the relationship between dexmedetomidine (DEX) use and SHS remains unclear.Objective To evaluate the association between DEX use and SHS in critically ill patients with IS.Methods This retrospective cohort study used MIMIC-IV v2.2. Patients with IS receiving mechanical ventilation were included. DEX exposure was defined as use within 72 hours after ICU admission. Multivariate logistic regression, inverse probability of treatment weighting (IPTW), restricted cubic splines, and subgroup analyses were performed.Results Among 953 patients, 146 (15.3%) received DEX. In the fully adjusted model, DEX use was associated with lower odds of SHS (OR = 0.611, 95% CI: 0.398–0.929, p = 0.023). The associations of cumulative DEX dose (p-nonlinearity = 0.018) and treatment duration (p-anonlinearity = 0.011) with SHS were nonlinear. Antiplatelet therapy significantly modified the DEX-SHS association (p-interaction = 0.042).Conclusion DEX use was associated with lower odds of SHS in critically ill patients with IS. Antiplatelet therapy may modify this association. Prospective studies are needed to confirm these findings.