Early levosimendan infusion, M-TEER, and tailored rehab improved stability and function in a 75-year-old with STEMI, cardiogenic shock, and severe MR.
Does early administration of levosimendan, M-TEER, and tailored cardiac rehabilitation improve functional outcomes in an elderly patient with STEMI complicated by cardiogenic shock and severe MR?
A multidisciplinary approach combining early haemodynamic stabilization with levosimendan, M-TEER, and cardiac rehabilitation can improve functional outcomes in high-risk elderly patients with STEMI complicated by cardiogenic shock.
Patients with acute ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock and severely reduced left ventricular ejection fraction (LVEF) face extremely poor prognosis, particularly elderly patients. Early initiation of cardiac rehabilitation is often limited by haemodynamic instability. A 75-year-old man with anterior STEMI treated with primary percutaneous coronary revascularization experienced multiple complications including cardiogenic shock, multiorgan dysfunction, persistent ventricular arrhythmias and severe mitral regurgitation (MR). Via a strong collaboration between a tertiary cardiac centre and rehabilitation facility, recurrent decompensation was treated with early administration of ino-dilators, mitral transcatheter edge-to-edge repair (M-TEER) and a tailored cardiac rehabilitation programme, providing net improvement in clinical stability, functional capacity and subsequent clinical outcomes. This case highlights the potential role of early haemodynamic stabilization with levosimendan, M-TEER and multidisciplinary rehabilitation in improving functional outcomes, even in high-risk elderly patients with STEMI complicated by cardiogenic shock and severely reduced LVEF.
Villaschi et al. (2026) studied this question. Early levosimendan infusion, M-TEER, and tailored rehab improved stability and function in a 75-year-old with STEMI, cardiogenic shock, and severe MR.