Levosimendan therapy does not improve survival of post-resuscitation cardiogenic shock patients

Introduction

The calcium sensitizer levosimendan enhances myocardial contractility, which could be advantageous in patients with myocardial ischemia requiring inotropic support.

Methods

During 3 years 3,852 patients with high-risk acute coronary syndrome (ACS) underwent percutaneous coronary intervention in our department. In 106 cases ACS was complicated with cardiogenic shock (mean age: 68.6 ± 1.2 years); moreover, in 26 cases patients had to be resuscitated (cardiopulmonary resuscitation (CPR)). Short-term and long-term effects of levosimendan on cardiac functions and on survival of cardiogenic shock and post-CPR patients were analyzed. Levosimendan was administrated in 39 of 106 cases as add-on therapy for patients with impaired left ventricular function, by extensive wall motion abnormality and by high blood cardiac enzyme concentration. Levosimendan therapy was started in most cases on the second or third day and applied for 6 hours as a continuous infusion (0.1 μg/kg/min). The mean time spent in the primary cardiac care center (inhospital time) was 6.0 ± 0.4 days, and the whole follow-up was 204.6 ± 29.9 days long.

Results

In the post-CPR patient group there was no significant difference in survival according to levosimendan treatment during short-term follow-up (36.5% vs. 40.0%, P = 0.790) and during long-term follow-up (15.6% vs. 15.0%, P = 0.754). On the other hand, for nonresuscitated patients the survival rates were significantly higher in the levosimendan-treated patient group during short-term follow-up (84.4% vs. 57.9%, P < 0.001) and during long-term follow-up (47.3% vs. 23.0%, P < 0.001). The time interval between the onset of myocardial infarction and percutaneous coronary intervention did not influence the effect of levosimendan on short-term and long-term mortality.

Conclusion

In summary, levosimendan may improve cardiac function and decrease short-term and even long-term mortality in cardiogenic shock patients independently of the time interval of myocardial infarction. This positive effect of levosimendan may be abolished by post-CPR patients.