Efficacy and safety of levosimendan in patients with ST‐segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: The LEVOCEST trial

• Published in: Catheterization and cardiovascular interventions 2024-12, Vol.104 (7), p.1414-1422
• Main Authors: Bosa Ojeda, Francisco, Méndez Vargas, Corabel, Lacalzada Almeida, Juan, Izquierdo Gómez, María M., Jiménez Sosa, Alejandro, Rodríguez Jiménez, Consuelo, Sánchez‐Grande Flecha, Alejandro, Bosa Santana, Marta, Yanes Bowden, Geoffrey
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty; Cardiotonic Agents - adverse effects; Cardiotonic Agents - therapeutic use; Coronary Artery Disease; Double-Blind Method; Echocardiography; Female; Heart; Heart attacks; Humans; Infusions, Intravenous; levosimendan; Male; Middle Aged; Myocardial infarction; Myocardium - pathology; Original ‐ Basic Science; Percutaneous Coronary Intervention - adverse effects; Placebos; primary angioplasty; Prospective Studies; Pyridazines - administration & dosage; Pyridazines - adverse effects; Recovery of Function; Reperfusion; reperfusion injury; Simendan - adverse effects; Simendan - therapeutic use; ST Elevation Myocardial Infarction - diagnosis; ST Elevation Myocardial Infarction - diagnostic imaging; ST Elevation Myocardial Infarction - physiopathology; ST Elevation Myocardial Infarction - therapy; Stroke Volume - drug effects; ST‐segment elevation; Time Factors; Treatment Outcome; Ventricle; Ventricular Function, Left - drug effects; Ventricular Remodeling - drug effects
• ISSN: 1522-1946; 1522-726X; 1522-726X
• DOI: 10.1002/ccd.31267

Background Primary angioplasty is the standard procedure for patients with ST‐segment elevation myocardial infarction (STEMI). However, myocardial reperfusion results in additional cell damage. Levosimendan, due to its pleiotropic effects, may be a therapeutic alternative to prevent this damage. The objective of this study was to evaluate whether this drug can reduce infarct size in patients with STEMI. Methods Patients were randomized to receive a 24‐h infusion of either levosimendan (0.1 μg/kg/min) or placebo after the primary angioplasty. The main objective was to assess the size of the infarct by cardiac resonance at 30 days and 6 months after the event. Other variables such as left ventricular ejection fraction (LVEF) and adverse ventricular remodeling (AVR) were assessed by speckle‐tracking echocardiography and magnetic resonance. Major adverse cardiovascular events (MACE) were also collected. Results 157 patients were analysed (levosimendan, n = 79; placebo, n = 78). We found that after 6 months, patients treated with levosimendan had a greater reduction in infarct size (13.19% ± 9.5% vs.11.79% ± 9%, p = 0.001), compared with those in the placebo group (13.35% ± 7.1% vs. 13.43% ± 7.8%, p = 0.38). There were no significant differences in MACE between both groups. Conclusions Levosimendan is a safe and effective therapeutic option for reducing infarct size in patients with STEMI.