# Pre-Procedural Use of Levosimendan in High-Risk ACS-PCI Patients with Reduced Left Ventricle Ejection Fraction—Short-Term Outcomes

## TL;DR

This study explores the safety of using levosimendan before high-risk heart procedures in patients with weak heart function, finding it to be relatively safe in the short term.

## Contribution

The study introduces and evaluates a new protocol of pre-procedural levosimendan use in high-risk ACS-PCI patients.

## Key findings

- The in-hospital death rate was low with pre-procedural levosimendan use.
- The MACCE rate was 7.8%, indicating moderate risk.
- Only two adverse events related to hypotension were observed.

## Abstract

Background/Objectives: Current evidence suggests that levosimendan may have a beneficial effect in the treatment of acute heart failure (AHF) or cardiogenic shock following primary percutaneous coronary intervention (PCI). However, there is a paucity of data on the use of levosimendan prior to PCI. Therefore, our pilot study aimed to assess the short-term prognosis of a new therapeutic protocol involving preprocedural infusion of levosimendan in patients with reduced left ventricular ejection fraction undergoing high-risk PCI for acute coronary syndrome (ACS). Methods: The study is a retrospective observational study, and the population includes all subjects who received levosimendan infusion prior to high-risk PCI for ACS. Subjects requiring urgent revascularization (cardiogenic shock, cardiac arrest) or with mechanical complications of ACS were excluded. Results: The study cohort consisted of 90 subjects, predominantly men (91.1%) with significantly reduced left ventricular function (28.7% (12)) and advanced coronary artery disease, mean SYNTAX Score 25.8 (19.3–33). During in-hospital follow-up, we observed 2 primary outcomes—death. The major adverse cardiac and cerebrovascular events (MACCE) rate was 7.8%. Two clinical adverse events that did not lead to discontinuation were observed during the in-hospital period. Both were related to hypotension. Conclusions: In short-term observation, novel therapeutic approach in the management of high-risk PCI in ACS patients—pre-procedural levosimendan—was a relatively safe approach. No significant adverse events were reported.