Cardiogenic shock after primary percutaneous coronary intervention: Effects of levosimendan compared with dobutamine on haemodynamics.
BACKGROUND
Levosimendan is a new calcium sensitizer with positive inotropic properties. Cardiac power output (CPO) has been shown to be instrumental in the diagnosis of cardiogenic shock (CS) and is an important determinant of outcomes.


OBJECTIVE
To evaluate the haemodynamic effects of levosimendan compared to dobutamine in acute myocardial infarction (AMI) patients revascularised by primary percutaneous coronary intervention (PCI), who developed CS.


RESULTS
Twenty two consecutive AMI patients revascularised by PCI, who developed CS, were randomly assigned to levosimendan (24 microg kg(-1) bolus plus 24-h continuous infusion 0,1 microg kg(-1) min(-1)) or dobutamine (initial dose 5 microg kg(-1) min(-1), with a maximum dose adjustment in order to reach the desired haemodynamic effect). Evaluations were performed from baseline to 30 h. The primary end-point was an increase > or =30% in CPO, after 24 h of therapy. The baseline clinical and haemodynamic characteristics were similar in both groups. Levosimendan had a consistently better effect on CPO than dobutamine, while the decrease in PCWP was similar.


CONCLUSIONS
The primary objective of our study was achieved better by the end of the 24 h infusion of levosimendan than by dobutamine.
Coronary Care Unit, Department of Cardiology, Hospital Universitario de Canarias, Ctra. La Cuesta-Taco. Ofra s/n. S, Cristóbal de La Laguna, E-38320 Sta. Cruz de Tenerife, Spain. mjgg181262@hotmail.com
Martín J
MJ
García-González
Alberto
A
Domínguez-Rodríguez
Julio J
JJ
Ferrer-Hita
Pedro
P
Abreu-González
Miguel Bethencourt
MB
Muñoz
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002302:Cardiac Output / Q000187:drug effects; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004280:Dobutamine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D006835:Hydrazones / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy; D011724:Pyridazines / Q000008:administration & dosage / Q000627:therapeutic use*; D012770:Shock, Cardiogenic / Q000188:drug therapy*; D000077464:Simendan; D016896:Treatment Outcome
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan; D004280:Dobutamine