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


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.


CONCLUSIONS
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.
Omerovic
Elmir
E
Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden. elmir@wlab.gu.se
Råmunddal
Truls
T
Albertsson
Per
P
Holmberg
Mikael
M
Hallgren
Per
P
Boren
Jan
J
Grip
Lars
L
Matejka
Göran
G
D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004562:Electrocardiography; D005260:Female; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D006835:Hydrazones / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D009204:Myocardial Revascularization; D016016:Proportional Hazards Models; D011724:Pyridazines / Q000627:therapeutic use*; D012737:Sex Factors; D012770:Shock, Cardiogenic / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D000077464:Simendan; D018709:Statistics, Nonparametric
D002316:Cardiotonic Agents; D006835:Hydrazones; D011724:Pyridazines; D000077464:Simendan