The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital of Shandong University, #107 West Wenhua Road, Ji'nan, 250012, People's Republic of China.
Department of Emergency, Donggang People's Hospital, Rizhao, 276800, People's Republic of China.
Am J Cardiovasc Drugs. 2017 Dec;17(6):453-463. doi: 10.1007/s40256-017-0237-0.
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.
急性冠状动脉综合征（ACS）并发心力衰竭（HF），包括心源性休克（CS）患者的预后仍然较差。
本研究旨在复习相关文献，评估左西孟旦治疗此类患者是否可获得更好的临床结局。
我们检索了 PubMed、EMBASE 和 Cochrane 图书馆数据库中，比较左西孟旦与任何对照药物治疗 ACS 并发 HF/CS 患者的随机对照试验。
本研究共纳入了 9 项试验的 1065 例患者。分析显示，左西孟旦可显著降低总死亡率和 HF 恶化发生率。在 HF-ACS 患者中，左西孟旦与降低死亡率相关。在 CS-ACS 患者中，两组间无显著差异。与安慰剂相比，左西孟旦降低死亡率的作用更显著，但与多巴酚丁胺相比则无显著差异。与对照组相比，左西孟旦降低肺动脉楔压和全身血管阻力，增加心指数，但两组间心率无显著差异。左西孟旦非显著增加低血压风险，但不增加缺血事件、窦性心动过速、心房颤动或室性心律失常风险。
左西孟旦似乎是一种有前途的药物，可降低 ACS 并发 HF/CS 患者的死亡率和 HF 恶化风险。它似乎提供了血流动力学获益，与低血压风险增加相关。
