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Curso de Atualização em Medicina Cardiovascular 2019
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Effects of levosimendan in patients with ST elevation acute myocardial infarction complicated with severe ventricular dysfunction and without cardiogenic shock at admission
Session:
Posters 3 - Écran 10 - Insuficiência Cardíaca
Speaker:
Bruno Piçarra
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.4 Acute Heart Failure– Treatment
Session Type:
Posters
FP Number:
---
Authors:
Bruno Cordeiro Piçarra; Antonio; Ana Rita Santos; Mafalda Carrington; Diogo Brás; Kisa Hyde Congo; José Eduardo Aguiar; Em nome dos investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p>~~Introduction: Levosimendan is an inodilator with inotropic properties often used in patients (Pts) with acute heart failure or cardiogenic shock. Its use Pts with acute ST-elevation myocardial infarction (STEMI) complicated by severe left ventricular dysfunction but without cardiogenic shock at admission is still unknown.<br /> Objective: To evaluate the effects of Levosimendan in a population of Pts with STEMI complicated by severe left ventricular dysfunction (defined as ejection fraction <30%) and without cardiogenic shock at admission.<br /> METHODS: We studied 289 Pts with STEMI complicated of severe left ventricular dysfunction and without cardiogenic shock at admission included in a national multicenter registry. We considered 2 groups: Pts who performed Levosimendan (n=23D) and Pts who did not perform Levosimendan (n=166Pts). We recorded age, gender, cardiovascular and non-cardiovascular history, vital signs, Killip-Kimbal (KK) class at admission, coronary angiography, coronary anatomy and in-hospital therapy. In-hospital mortality was assessed as the primary end point and secondary end points were defined as the presence of one of the following complications: Re-AMI, high-grade atrial-ventricular (AVB), sustained ventricular tachycardia (VT) and atrial fibrillation (AF). Multivariate analysis was performed to evaluate the impact of Levosimendan in each of the endpoints considered.<br /> Results: The baseline characteristics between the two groups were very similar, with no statistically significant differences between age, gender and cardiovascular and non-cardiovascular history. At admission, vital signs (systolic and diastolic blood pressure, heart rate), as well as KK class were similar between the 2 groups. The coronary angiography rate was similar between the groups, with no difference in the number of vessels with lesions or the number of angioplasties performed. Although Levosimendan was used in a greater number of Pts who developed heart failure (87,0% vs 59,0%, p=0,008) and cardiogenic shock (52,4% vs 26,0%, p=0,01), in-hospital mortality was similar between groups. There were no differences in any of the secondary endpoints (Re-EAM, AVB, TVM and AF).<br /> CONCLUSIONS: In the context of STEMI complicated by severe left ventricular dysfunction, the use of Levosimendan appears to be safe, not associated with increased in-hospital mortality or complications.<br /> </p>
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