Levosimendan neither improves nor worsens mortality in patients with cardiogenic shock due to ST-elevation myocardial infarction

• Published in: Vascular health and risk management 2010, Vol.7 (6), p.657
• Main Authors: Omerovic, Elmir, Råmunddal, Truls, Albertsson, Per, Holmberg, Mikael, Hallgren, Per, Borén, Jan, Grip, Lars, Matejka, Göran
• Format: Article
• Language: English
• Subjects: Dermatologi och venereologi; Dermatology and Venereal Diseases; heart failure; inotropic agents; myocardial infarction; pharmacology; shock
• ISSN: 1178-2048

BACKGROUND: The aim of this study was to evaluate the effect of levosimendan on mortality in cardiogenic shock (CS) after ST elevation myocardial infarction (STEMI). METHODS AND RESULTS: Data were obtained prospectively from the SCAAR (Swedish Coronary Angiography and Angioplasty Register) and the RIKS-HIA (Register of Information and Knowledge about Swedish Heart Intensive Care Admissions) about 94 consecutive patients with CS due to STEMI. Patients were classified into levosimendan-mandatory and levosimendan-contraindicated cohorts. Inotropic support with levosimendan was mandatory in all patients between January 2004 and December 2005 (n = 46). After the SURVIVE and REVIVE II studies were presented, levosimendan was considered contraindicated and was not used in consecutive patients between December 2005 and December 2006 (n = 48). The cohorts were similar with respect to pre-treatment characteristics and concomitant medications. There was no difference in the incidence of new-onset atrial fibrillation, in-hospital cardiac arrest and length of stay at the coronary care unit. There was no difference in adjusted mortality at 30 days and at one year. CONCLUSION: The use of levosimendan neither improves nor worsens mortality in patients with CS due to STEMI. Well-designed randomized clinical trials are needed to define the role of inotropic therapy in the treatment of CS.