Abstract
The treatment of acute myocardial infarction is early revascularization. Heart failure and cardiogenic shock may complicate acute myocardial infarction despite applying the best available strategy. Levosimendan is a relatively new drug to treat heart failure with a peculiar mechanism of action: calcium sensitization of myocardial fibres. Levosimendan has a direct inotropic effect but also pleiotropic effects; through the K+ATP channel’s opening, it also has a vasodilator effect which may participate concretely in the global effects of the drug. The focus of the literature is on the anti-heart failure and anti-cardiogenic shock properties of Levosimendan, but it may have effects also preventing the development of myocardial insufficiency in acute myocardial infarction. The aim of the meta-analysis is to evaluate the effect of Levosimendan on acute myocardial infarction in placebo-controlled trials. Based on the eight studies selected, we found a beneficial effect of Levosimendan on acute and long-term mortality of patients affected by acute myocardial infarction. With caution in interpreting the results of this meta-analysis, our data support the idea that Levosimendan may already have a role in the treatment of acute ischemic heart disease. Further studies specifically designed to investigate the early role in the treatment of ischemic heart failure are needed.
Highlights
All the studies were balanced in terms of age of the population and prevalence of the female sex, as well as diabetes and previous myocardial infarction, with the population of the studies being composed mainly of ST-elevation myocardial infarction (STEMI) patients
Great variability was present in the timeline after the start of the treatment/placebo when haemodynamic parameters are collected in each study: from 120 h for Husebye to 20 min for Sonntag (Table 3)
If the pure haemodynamic effect of Levosimendan, as well as the intra-aortic balloon pump (IABP) support, may act on very short mortality, it disappears after the stop of the infusion and with it, the effect on long term mortality, as well as the IABP support [21]
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. The first line of treatment for patients affected by acute myocardial infarction (AMI). Is the early revascularization with PCI [1]. 5% of myocardial infarctions needing adjunctive support. The utility on the long-term survival of mechanical support such as intra-aortic balloon pump (IABP) [2] or ECMO [3]
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