Efficacy and safety of levosimendan in patients with ST‐segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: The LEVOCEST trial

Abstract

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.