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Differences between surviving and non-surviving patients treated with levosimendan for acute myocardial ischemia

A. Lehmann1, A.-H. Kiessling2, C. Zeitler1, J. Lang1, F. Isgro2, J. Boldt1
1Department of Anesthesiology and Intensive Care Medicine, 2Department of Cardiac Surgery, Klinikum der Stadt Ludwigshafen, Germany
[Applied Cardiopulmonary Pathophysiology 12: 33-39, 2008]

Abstract

Introduction: Levosimendan, a calcium sensitizer and opener of ATP-dependent potassium channels, has positive inotropic, vasodilatory, and cardioprotective properties.
Method: 28 patients with acute myocardial infarction and/or cardiogenic shock (50%) scheduled for emergency surgical revascularization were treated with levosimendan in addition to catecholamines.
Results: 21 (75%) patients survived (SP), 7 (25%) patients died (NSP) within 30 days. Predicted mortality by logistic EuroSCORE for all 28 patients was 42±22%. Survivors had a lower (p<0.05) predicted mortality (35±17%) than the NSP (71±16%). SP were younger (p<0.05) (59±9 years) compared to NSP (71±8 years). Cardiac index was significantly higher in SP compared to NSP after cardiopulmonary bypass. An intraaortic balloon pump was inserted in 19% of the SP and in 71% of the NSP (p<0.05). Dialysis for renal failure was needed in 1 (5%) of the SP and in 2 (29%) of the NSP (n.s.). Surviving patients were ventilated for 26±20h, treated at the intensive care unit for 5.1±4.9 days, and dismissed from hospital after 15±19 days.
Conclusions: Surviving patients were younger, less severely ill and had fewer complications compared to non-surviving patients. Whether levosimendan is beneficial in patients with acute ischemia undergoing cardiac surgery must be answered by a prospective randomized trial.

Key words: ischemia/reperfusion, myocardial infarction, myocardial protection, preconditioning


Address for corresponding: Andreas Lehmann, M.D., Department of Anesthesiology and Intensive Care Medicine, Klinikum der Stadt Ludwigshafen, Postfach 21 73 52, D-67073 Ludwigshafen, Germany, E-Mail: Öffnet ein Fenster zum Versenden einer E-Maillehmann@bitte-keinen-spamklilu.de



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