title: Intracoronary administration of darbepoetin-alpha at onset of reperfusion in acute myocardial infarction: results of the randomized Intra-Co-EpoMI trial.
abstract: BACKGROUND
  Several trials investigating erythropoietin as a novel cytoprotective agent in myocardial infarction (MI) failed to translate promising preclinical results into the clinical setting. These trials could have missed crucial events occurring in the first few minutes of reperfusion. Our study differs by earlier intracoronary administration of a longer-acting erythropoietin analogue at the onset of reperfusion.
  
  
  OBJECTIVE
  To evaluate the ability of intracoronary administration of darbepoetin-alpha (DA) at the very onset of the reperfusion, to decrease infarct size (IS).
  
  
  METHODS
  We randomly assigned 56 patients with acute ST-segment elevation MI to receive an intracoronary bolus of DA 150 μg (DA group) or normal saline (control group) at the onset of reflow obtained by primary percutaneous coronary intervention (PCI). IS and area at risk (AAR) were evaluated by biomarkers, cardiac magnetic resonance (CMR) and validated angiographical scores.
  
  
  RESULTS
  There was no difference between groups regarding duration of ischemia, Thrombolysis in Myocardial Infarction flow grade at admission and after PCI, AAR size and extent of the collateral circulation, which are the main determinants of IS. The release of creatine kinase was not significantly different between the two groups even when adjusted to AAR size. Between 3-7 days and at 3 months, the area of hyperenhancement on CMR expressed as a percentage of the left ventricular myocardium was not significantly reduced in the DA group even when adjusted to AAR size.
  
  
  CONCLUSIONS
  Early intracoronary administration of a longer-acting erythropoietin analogue in patients with acute MI at the time of reperfusion does not significantly reduce IS.
authors.affiliation: Département de Cardiologie, Pôle cœur-poumon, Hôpital Arnaud-de-Villeneuve, CHU de Montpellier, UFR de Médecine, Université Montpellier 1, CNRS, UMR-5203, France. francois.roubille@gmail.com
authors.forename: François
authors.initials: F
authors.lastname: Roubille
authors.forename: Antoine
authors.initials: A
authors.lastname: Micheau
authors.forename: Stéphane
authors.initials: S
authors.lastname: Combes
authors.forename: Séverine
authors.initials: S
authors.lastname: Thibaut
authors.forename: Géraud
authors.initials: G
authors.lastname: Souteyrand
authors.forename: Guillaume
authors.initials: G
authors.lastname: Cayla
authors.forename: Laurent
authors.initials: L
authors.lastname: Bonello
authors.forename: Nathalie
authors.initials: N
authors.lastname: Lesavre
authors.forename: Catherine
authors.initials: C
authors.lastname: Sportouch-Dukhan
authors.forename: François
authors.initials: F
authors.lastname: Klein
authors.forename: Samir
authors.initials: S
authors.lastname: Berboucha
authors.forename: Stéphane
authors.initials: S
authors.lastname: Cade
authors.forename: Thien-Tri
authors.initials: TT
authors.lastname: Cung
authors.forename: Franck
authors.initials: F
authors.lastname: Raczka
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Macia
authors.forename: Richard
authors.initials: R
authors.lastname: Gervasoni
authors.forename: Frédéric
authors.initials: F
authors.lastname: Cransac
authors.forename: Florence
authors.initials: F
authors.lastname: Leclercq
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Barrère-Lemaire
authors.forename: Franck
authors.initials: F
authors.lastname: Paganelli
authors.forename: Pascal
authors.initials: P
authors.lastname: Mottref
authors.forename: Hélène
authors.initials: H
authors.lastname: Vernhet Kovacsik
authors.forename: Michel
authors.initials: M
authors.lastname: Ovize
authors.forename: Christophe
authors.initials: C
authors.lastname: Piot
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003097:Collateral Circulation; D017023:Coronary Angiography; D003326:Coronary Circulation; D003402:Creatine Kinase / Q000097:blood; D000068256:Darbepoetin alfa; D004334:Drug Administration Schedule; D004921:Erythropoietin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D005602:France; D006801:Humans; D007269:Injections, Intra-Arterial; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016037:Single-Blind Method; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D004921:Erythropoietin; D000068256:Darbepoetin alfa; D003402:Creatine Kinase