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

BackgroundPrimary 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.MethodsPatients were randomized to receive a 24-h infusion of either levosimendan (0.1 mu g/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.Results157 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.ConclusionsLevosimendan is a safe and effective therapeutic option for reducing infarct size in patients with STEMI.