| Levosimendan is superior to enoximone in refractory cardiogenic shock complicating acute myocardial infarction. | |
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MedLine Citation:
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PMID: 18664782 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Cardiogenic shock is the leading cause of death in patients hospitalized for acute myocardial infarction. The objectives were to investigate the effects of levosimendan, a novel inodilator, compared with the phosphodiesterase-III inhibitor enoximone in refractory cardiogenic shock complicating acute myocardial infarction, on top of current therapy. DESIGN: Prospective, randomized, controlled single-center clinical trial. SETTING: Medical and coronary intensive care unit in a university hospital. PATIENTS: Thirty-two patients with refractory cardiogenic shock for at least 2 hrs requiring additional therapy. INTERVENTIONS: Infusion of either levosimendan (12 microg/kg over 10 min, followed by 0.1 microg/kg/min over 50 min, and of 0.2 microg/kg/min for the next 23 hrs) or enoximone (fractional loading dose of 0.5 mg/kg, followed by 2-10 microg/kg/min continuously) after initiation of current therapy, always including revascularization, intra-aortic balloon pump counterpulsation, and inotropes. MEASUREMENTS AND MAIN RESULTS: Survival rate at 30 days was significantly higher in the levosimendan-treated group (69%, 11 of 16) compared with the enoximone group (37%, 6 of 16, p = 0.023). Invasive hemodynamic parameters during the first 48 hrs were comparable in both groups. Levosimendan induced a trend toward higher cardiac index, cardiac power index, left ventricular stroke work index, and mixed venous oxygen saturation. In addition, lower cumulative values for catecholamines at 72 hrs and for clinical signs of inflammation were seen in the levosimendan-treated patients. Multiple organ failure leading to death occurred exclusively in the enoximone group (4 of 16 patients). CONCLUSIONS: In severe and refractory cardiogenic shock complicating acute myocardial infarction, levosimendan, added to current therapy, may contribute to improved survival compared with enoximone. |
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Authors:
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Joerg T Fuhrmann; Alexander Schmeisser; Matthias R Schulze; Carsten Wunderlich; Steffen P Schoen; Thomas Rauwolf; Christof Weinbrenner; Ruth H Strasser |
Publication Detail:
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Type: Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: Critical care medicine Volume: 36 ISSN: 1530-0293 ISO Abbreviation: Crit. Care Med. Publication Date: 2008 Aug |
Date Detail:
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Created Date: 2008-07-30 Completed Date: 2008-08-25 Revised Date: 2009-08-18 |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 2257-66 Citation Subset: AIM; IM |
Affiliation:
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Department of Internal Medicine and Cardiology, Heart Center Dresden-University Hospital, University of Technology, Dresden, Germany. joerg.fuhrmann@lycos.de |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cardiotonic Agents / therapeutic use* Coronary Care Units Enoximone / therapeutic use* Female Hemodynamics Hospital Mortality Humans Hydrazones / therapeutic use* Kaplan-Meiers Estimate Male Middle Aged Myocardial Infarction / complications*, diagnosis Phosphodiesterase Inhibitors / therapeutic use* Pyridazines / therapeutic use* Shock, Cardiogenic / drug therapy*, etiology, mortality |
| Chemical | |
Reg. No./Substance:
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0/Cardiotonic Agents; 0/Hydrazones; 0/Phosphodiesterase Inhibitors; 0/Pyridazines; 131741-08-7/simendan; 77671-31-9/Enoximone |
| Comments/Corrections | |
Comment In:
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Crit Care Med. 2008 Aug;36(8):2450-1
[PMID:
18664796
]
Crit Care Med. 2009 Mar;37(3):1181-2 [PMID: 19237968 ] Crit Care Med. 2009 Mar;37(3):1182 [PMID: 19237971 ] Crit Care Med. 2009 Sep;37(9):2678; author reply 2678-9 [PMID: 19687655 ] |
Erratum In:
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Crit Care Med. 2008 Oct;36(10):2966 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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