Effects of Levosimendan on Patients with Heart Failure Complicating Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials
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The prognosis for patients with heart failure (HF), including cardiogenic shock (CS), complicating acute coronary syndrome (ACS) remains poor.
This study aimed to review the relevant literature and evaluate whether levosimendan was associated with better clinical outcomes in these patients.
We searched PubMed, EMBASE, and the Cochrane library databases for randomized controlled trials that investigated levosimendan compared with any control in patients with HF/CS complicating ACS.
A total of 1065 patients from nine trials were included in this study. Analysis showed that levosimendan significantly reduced total mortality and the incidence of worsening HF. In patients with HF-ACS, levosimendan was associated with reduced mortality. In patients with CS-ACS, no significant difference was observed between the two groups. Levosimendan contributed to significantly reduced mortality when compared with placebo, but no significant reduction was seen compared with dobutamine. Compared with controls, levosimendan decreased pulmonary capillary wedge pressure and systemic vascular resistance and increased cardiac index, with no significant difference observed between the groups in terms of heart rate. Levosimendan non-significantly increased the risk of hypotension but did not increase the risk of ischemic episodes, sinus tachycardia, atrial fibrillation, or ventricular arrhythmias.
Levosimendan appears to be a promising drug to reduce mortality and worsening HF in patients with HF/CS-ACS. It appears to provide hemodynamic benefit and was associated with an increased risk of hypotension.
Compliance with Ethical Standards
This study was funded by research grants from the State Program of National Science Foundation of China for Innovative Research Group (Grant 81321061), the National Natural Science Foundation of China (91439201, 81100605, 81270352, 81270287, 81300168, 81471036, 81470560, and 81570400), the Natural Science Foundation of Shandong Province (ZR2014HQ037), the Specialized Research Fund for the Doctoral Program of Higher Education (SRFDP 20130131120065), and Key Research and Development Program of Shandong Province (2015GSF118062).
Conflicts of interest
GS, XY, DS, YT, YS, ZW, MT, YZ, WZ, and MZ have no conflicts of interest that might be relevant to the contents of this manuscript.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
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