Efficacy and safety of levosimendan in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: The LEVOCEST trial
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Published on: May 28, 2019
Francisco Bosa Ojeda1,2, Corabel Méndez Vargas1,2, Juan Lacalzada Almeida2
1Department of Interventional Cardiology, University Hospital of the Canary Islands, La Laguna, Santa Cruz de Tenerife, Canary Islands, Spain.
Insights
Levosimendan effectively reduces infarct size in ST-segment elevation myocardial infarction (STEMI) patients after primary angioplasty. This therapy is safe and improves myocardial reperfusion outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Medical Research
Background:
- Primary angioplasty is standard for ST-segment elevation myocardial infarction (STEMI).
- Myocardial reperfusion post-angioplasty can cause additional cell damage.
- Levosimendan's pleiotropic effects offer potential to mitigate reperfusion injury.
Purpose of the Study:
- To evaluate levosimendan's efficacy in reducing infarct size in STEMI patients.
- To assess the impact of levosimendan on myocardial damage following primary angioplasty.
Main Methods:
- Randomized controlled trial involving 157 STEMI patients.
- 24-hour infusion of levosimendan or placebo post-primary angioplasty.
- Infarct size assessed by cardiac MRI; LVEF and remodeling by echocardiography; MACE collected.
Main Results:
- Levosimendan group showed a significantly greater reduction in infarct size at 6 months (p=0.001).
- No significant difference in Major Adverse Cardiovascular Events (MACE) between groups.
- Left ventricular ejection fraction and adverse ventricular remodeling were also assessed.
Conclusions:
- Levosimendan is a safe therapeutic option for reducing infarct size in STEMI.
- The drug demonstrates effectiveness in mitigating myocardial damage post-reperfusion.
- Further research may explore long-term benefits and specific patient populations.
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.
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