AccScience Publishing / EJMO / Online First / DOI: 10.36922/EJMO025260284
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ORIGINAL RESEARCH ARTICLE

Levosimendan for myocardial protection in unstable angina patients undergoing elective percutaneous coronary intervention: A prospective randomized controlled trial

Fengming Jia1 ,  Jingzhao Sun1 ,  Jinlin Ren1 ,  Mengqi Wang1 ,  Jiantao Song2 ,  Bo Hu1* ,  Jing Zhong2*
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1 Department of Emergency, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
2 Department of Interventional Diagnosis and Treatment, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
EJMO, 025260284 https://doi.org/10.36922/EJMO025260284
Received: 29 June 2025 | Revised: 2 October 2025 | Accepted: 20 October 2025 | Published online: 21 November 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Introduction: Unstable angina patients undergoing percutaneous coronary intervention (PCI) face a risk of myocardial injury; identifying effective cardioprotective agents such as levosimendan is crucial to improve outcomes.

Objective: This study aimed to evaluate the cardioprotective effects of levosimendan in patients with unstable angina undergoing elective PCI.

Methods: A randomized, double-blind, placebo-controlled trial involving 121 participants was conducted. The participants were assigned to either the levosimendan group (0.1 μg/kg/min for 24 h, n = 61) or the placebo group (5% dextrose for 24 h, n = 60). The primary outcomes were myocardial injury markers and PCI-related myocardial infarction, whereas the secondary outcomes included inflammatory markers and cardiac function, which were assessed over a 6-month follow-up period.

Results: The levels of high-sensitivity troponin T (hs-TnT) and creatine phosphokinase-myocardial band isoenzyme were found to increase 24 h after PCI in both groups. However, the increase was significantly greater in the placebo group than in the levosimendan group (p<0.05). In the levosimendan group, five participants had hs-TnT levels exceeding 5 times the upper reference limit, and one patient experienced an acute myocardial infarction (AMI). In contrast, 14 participants in the placebo group had hs-TnT levels exceeding this threshold (odds ratio [OR] = 0.293; 95% confidence interval [CI]: 0.098–0.875, p=0.028). Moreover, eight participants experienced PCI-related AMI (OR = 0.108; 95% CI: 0.013–0.895, p=0.039). After PCI, both groups showed elevated levels of the inflammatory marker, including C-reactive protein and interleukin-6; however, these elevations were significantly lower in the levosimendan group (p<0.05).

Conclusion: The perioperative administration of levosimendan in participants with unstable angina pectoris undergoing elective PCI can effectively reduce post-operative myocardial injury.

Graphical abstract
Keywords
Levosimendan
Unstable angina pectoris
High-sensitivity troponin T
Creatine kinase-myocardial band
Myocardial injury
Percutaneous coronary intervention-related acute myocardial infarction
Funding
This study was supported by the Traditional Chinese Medicine Science and Technology Project of Shandong Province (Z-2023001).
Conflict of interest
The authors declare that they have no competing interests.
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Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
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