Myocardial Infarction, Outcome
Conditions
Brief summary
In the proposed project the investigators want to assess whether the approach of the post-conditioning by Levosimendan in patients with acute STEMI is safe and reproducible, can be used with a positive influence on the outcomes with respect to myocardial damage, cardiac left ventricular remodeling, myocardial function, the occurrence of cardiac events and quality of life.
Detailed description
An acute ST-elevation myocardial infarction (STEMI) is a severe disease that triggers an adverse remodeling, and served in progressive heart failure with a case fatality rate of 50% in 5 years. The opening of the occluded vessel is the first and most important therapy, the reperfusion improved both the function as well as the long-term survival. At the same time, experimental and clinical studies show, however, that this reperfusion self-reinforced damage of the myocardium. An additional Intervention in this trigger phase could not only reduce the acute damage, but long-term protective effects. Both effects could be an approach for the Calcium-Sensitizer Levosimendan in the animal model. So far, no clear effect on the remodeling and survive was demonstrated after myocardial infarction in the clinic. This could be mainly due to the delayed application in relation to the reperfusion and on the selection of suitable methods for the presentation of the effects on myocardial structure and function. In the proposed project the investigators want to assess whether the approach of the post-conditioning by Levosimendan in patients with acute STEMI is safe and reproducible, can be used with a positive influence on the outcomes with respect to myocardial damage, cardiac left ventricular remodeling, myocardial function, the occurrence of cardiac events and quality of life.
Interventions
DRUGLevosimendan
In a prospective randomized setting, patients are included with an acute STEMI of the anterior wall. A bolus administration Levosimendan with/without following continuous infusion over 24 hours compared to a control group (placebo) will be examined. The initiation of therapy is carried out for 10 min. prior to reperfusion. The coronary Intervention is performed immediately after inclusion at the latest within 6 hours after the onset of symptoms. The administration of Levosimendan is based on a fixed schema: Bolus: 12 µg/kg over 10 min I. V., starting 10 min before recanalization and an addition of 0.1-0.2 µg/kg/min i. v. for 24 hours in the continuous infusion group.
Sponsors
RWTH Aachen University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* STEMI of the anterior wall \< 6 hrs * capacity to Consent
Exclusion criteria
* previous myocardial infarction or bypass surgery * relevant vitium * STEMI of the posterior wall * any contraindications to MRI * unstable hemodynamics (hypotension, catecholamine therapy, severe arrhythmia), -respiratory failure * onset of symptoms more than 6 hours.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Reduction of the increase in left ventricular end-diastolic volume index (LVEDVi) | 12 months after coronary intervention due to the infarction | echocardiography and MRI examinations (LVEDVi) and comparison between baseline and 12 months data |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Size of the acute myocardial damage due to the infarction | 12 months after coronary intervention due to the infarction | MRI examination (infarction area) and comparison between baseline and 12 months data |
| Event-free survival | 12 months after coronary intervention due to the infarction | collection of data from the patient after 12 months about adverse events as myocardial infarction, stroke, revascularization and death |
| functional changes (imaging) | 12 months after coronary intervention due to the infarction | echocardiography and MRI examinations about LV function |
| structural changes | 12 months after coronary intervention due to the infarction | MRI examinations about fibrosis |
| functional changes (spirometry) | 12 months after coronary intervention due to the infarction | changes of capacity by spirometry. |
Outcome results
None listed