A single dose of erythropoietin in ST-elevation myocardial infarction.
OBJECTIVE
Cardioprotective effects of erythropoietin (EPO) have been shown in experimental and smaller clinical studies. We performed a prospective, multicentre, randomized trial to assess the effects of a single high dose of EPO after primary coronary intervention (PCI) for an ST-elevation myocardial infarction (STEMI). Methods and results Patients with a successful PCI for a first STEMI were randomized to receive either standard medical care alone, or in combination with a single bolus with 60,000 IU i.v. of epoetin alfa within 3 h after PCI. Primary endpoint was left ventricular ejection fraction (LVEF) after 6 weeks, assessed by planar radionuclide ventriculography. Pre-specified secondary endpoints included enzymatic infarct size and major adverse cardiovascular events. A total of 529 patients were enrolled (EPO n = 263, control n = 266). At baseline (before EPO administration), groups were well-matched for all relevant characteristics. After a mean of 6.5 (± 2.0) weeks, LVEF was 0.53 (± 0.10) in the EPO group and 0.52 (± 0.11) in the control group (P = 0.41). Median area under the curve (inter-quartile range) after 72 h for creatinine kinase was 50 136 (28 212-76 664)U/L per 72 h in the EPO group and 53 510 (33 973-90 486)U/L per 72 h in the control group (P = 0.058). More major adverse cardiac events occurred in the control than in the EPO group (19 vs. 8; P = 0.032). Conclusion A single high dose of EPO after a successful PCI for a STEMI did not improve LVEF after 6 weeks. However, the use of EPO was related to less major adverse cardiovascular events and a favourable clinical safety profile.


BACKGROUND
NCT00449488; http://www.clinicaltrials.gov/ct2/show/NCT00449488?term=voors&rank=2.
Voors
Adriaan A
AA
Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands. a.a.voors@thorax.umcg.nl
Belonje
Anne M S
AM
Zijlstra
Felix
F
Hillege
Hans L
HL
Anker
Stefan D
SD
Slart
Riemer H J A
RH
Tio
René A
RA
van 't Hof
Arnoud
A
Jukema
J Wouter
JW
Peels
Hans Otto J
HO
Henriques
José P S
JP
Ten Berg
Jurriën M
JM
Vos
Jeroen
J
van Gilst
Wiek H
WH
van Veldhuisen
Dirk J
DJ
D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D003131:Combined Modality Therapy; D004562:Electrocardiography; D000068817:Epoetin Alfa; D004921:Erythropoietin / Q000008:administration & dosage*; D005260:Female; D006397:Hematinics / Q000008:administration & dosage*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D011446:Prospective Studies; D015635:Radionuclide Ventriculography / Q000379:methods; D011994:Recombinant Proteins / Q000008:administration & dosage; D017211:Treatment Failure; D018487:Ventricular Dysfunction, Left / Q000628:therapy
D006397:Hematinics; D011994:Recombinant Proteins; D004921:Erythropoietin; D000068817:Epoetin Alfa