© 2006 European Society of Cardiology
Cardiogenic shock after primary percutaneous coronary intervention: Effects of levosimendan compared with dobutamine on haemodynamics
a Coronary Care Unit, Department of Cardiology, Hospital Universitario de Canarias, Ctra. La Cuesta — Taco. Ofra s/n. S, Cristóbal de La Laguna, E-38320 Sta. Cruz de Tenerife, Spain
b Department of Physiology, School of Medicine, University of La Laguna, Tenerife, Canary Islands, Spain
* Corresponding author. Tel.: +34 922679030; fax: +34 922 362716. E-mail address: mjgg181262{at}hotmail.com (M.J. García-González).
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Abstract |
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Background: Levosimendan is a new calcium sensitizer with positive inotropic properties. Cardiac power output (CPO) has been shown to be instrumental in the diagnosis of cardiogenic shock (CS) and is an important determinant of outcomes.
Aims: To evaluate the haemodynamic effects of levosimendan compared to dobutamine in acute myocardial infarction (AMI) patients revascularised by primary percutaneous coronary intervention (PCI), who developed CS.
Methods and results: Twenty two consecutive AMI patients revascularised by PCI, who developed CS, were randomly assigned to levosimendan (24µg kg–1 bolus plus 24-h continuous infusion 0,1µg kg–1 min–1) or dobutamine (initial dose 5µg kg–1 min–1, with a maximum dose adjustment in order to reach the desired haemodynamic effect). Evaluations were performed from baseline to 30h. The primary end-point was an increase 
30% in CPO, after 24h of therapy. The baseline clinical and haemodynamic characteristics were similar in both groups. Levosimendan had a consistently better effect on CPO than dobutamine, while the decrease in PCWP was similar.
Conclusion: The primary objective of our study was achieved better by the end of the 24h infusion of levosimendan than by dobutamine.
Key Words: Levosimendan • Cardiogenic shock • Acute myocardial infarction • Cardiac power output • Cardiac reserve • Treatment
Received April 14, 2005; Revised July 6, 2005; Accepted January 3, 2006
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