title: Effect of erythropoietin as an adjunct to primary percutaneous coronary intervention: a randomised controlled clinical trial.
abstract: OBJECTIVE
  The acute administration of high-dose erythropoietin (EPO) on reperfusing ischaemic myocardium has been reported to halve myocardial infarct (MI) size in preclinical studies, but its effect in ST elevation myocardial infarction patients undergoing primary percutaneous coronary intervention (PPCI) remains unknown. We investigated whether high-dose EPO administered as an adjunct to PPCI reduces MI size.
  
  
  METHODS
  Double-blinded, randomised, placebo-controlled.
  
  
  METHODS
  Single tertiary cardiac centre.
  
  
  METHODS
  Fifty-one ST elevation myocardial infarction patients undergoing PPCI.
  
  
  METHODS
  Patients were randomly assigned to receive either a single intravenous bolus of EPO (50,000 IU) prior to PPCI with a further bolus given 24 h later (n=26) or placebo (n=25).
  
  
  METHODS
  MI size measured by 24 h area under the curve troponin T and cardiac magnetic resonance imaging performed on day 2 and at 4 months.
  
  
  RESULTS
  EPO treatment failed to reduce MI size (troponin T area under the curve: 114.6±78 μg/ml EPO vs 100.8±68 μg/ml placebo; infarct mass by cardiac magnetic resonance: 33±16 g EPO vs 25±16 g placebo; both p>0.05). Unexpectedly, EPO treatment doubled the incidence of microvascular obstruction (82% EPO vs 47% placebo; p=0.02) and significantly increased indexed left ventricular (LV) end-diastolic volumes (84±10 ml/m(2) EPO vs 73±13 ml/m(2) placebo; p=0.003), indexed LV end-systolic volumes (41±9 ml/m(2) EPO vs 35±11 ml/m(2) placebo; p=0.035) and indexed myocardial mass (89±16 g/m(2) EPO vs 79±11 g/m(2) placebo; p=0.03). At 4 months, there were no significant differences between groups.
  
  
  CONCLUSIONS
  High-dose EPO administered as an adjunct to PPCI failed to reduce MI size. In fact, EPO treatment was associated with an increased incidence of microvascular obstruction, LV dilatation and increased LV mass. Clinical Trial Registration Information http://public.ukcrn.org.uk/search/StudyDetail.aspx?StudyID=4058 Unique Identifier=Study ID 4058.
authors: The Hatter Cardiovascular Institute, University College London, London, UK.
authors: Andrew J
authors: AJ
authors: Ludman
authors: Derek M
authors: DM
authors: Yellon
authors: Jonathan
authors: J
authors: Hasleton
authors: Cono
authors: C
authors: Ariti
authors: Girish Ganesha
authors: GG
authors: Babu
authors: Edney
authors: E
authors: Boston-Griffiths
authors: Vinod
authors: V
authors: Venugopal
authors: Malcolm
authors: M
authors: Walker
authors: Diana
authors: D
authors: Holdright
authors: Howard
authors: H
authors: Swanton
authors: Tom
authors: T
authors: Crake
authors: David
authors: D
authors: Brull
authors: James C
authors: JC
authors: Moon
authors: Rajesh
authors: R
authors: Puranik
authors: Vivek
authors: V
authors: Muthurangu
authors: Vivek
authors: V
authors: Mutharangu
authors: Andrew
authors: A
authors: Taylor
authors: Derek J
authors: DJ
authors: Hausenloy
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D003326:Coronary Circulation / Q000187:drug effects; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004921:Erythropoietin / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006397:Hematinics / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000503:physiopathology; D007275:Injections, Intravenous; D008131:London; D008279:Magnetic Resonance Imaging; D008297:Male; D008833:Microcirculation / Q000187:drug effects; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D009206:Myocardium / Q000473:pathology; D015990:Placebo Effect; D011994:Recombinant Proteins; D013318:Stroke Volume / Q000187:drug effects; D013997:Time Factors; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D015415:Biomarkers; D006397:Hematinics; D011994:Recombinant Proteins; D020107:Troponin T; C103998:epoetin beta; D004921:Erythropoietin