Levosimendan in patients with acute myocardial ischaemia undergoing emergency surgical revascularization

Levosimendan is a calcium-sensitizing drug that enhances myocardial contractility without increasing intracellular calcium. By activating adenosine triphosphate-dependent potassium channels it exerts cardioprotective and vasodilatory effects.

A retrospective matched pair analysis was performed in 52 patients undergoing emergency coronary artery bypass grafting for acute myocardial ischaemia with or without cardiogenic shock. A total of 27 patients received levosimendan (bolus 6 microg kg(-1); continuous infusion 0.2 microg kg(-1) min(-1)) in addition to catecholamines, while 25 patients were treated with catecholamines only.

Predicted mortality by logistic EuroSCORE was 42% (14-90%) in the levosimendan group and 38% (9-90%) in the control group (median, range). Cardiogenic shock was diagnosed in 52% of the patients in both groups. Compared to the control group, levosimendan-treated patients had fewer intra-aortic balloon pumps inserted (33% vs. 76%, P 0.05) and need for dialysis (11% levosimendan; 32% control, P > 0.05) did not reach statistical significance. Length of hospital stay did not differ (14 +/- 18 days, levosimendan; 13 +/- 19 days, control; P > 0.05) between the two groups.

In this retrospective matched pair analysis of 52 patients undergoing emergency coronary artery bypass grafting for acute ischaemia, levosimendan reduced morbidity. The reduced morbidity did not translate into reductions in mortality or length of stay. A larger, prospective randomized trial is warranted to confirm the potentially beneficial effects of levosimendan in patients with acute ischaemia.