title: Safety and clinical outcome of erythropoiesis-stimulating agents in patients with ST-elevation myocardial infarction: a meta-analysis of individual patient data.
abstract: BACKGROUND
  Erythropoiesis-stimulating agents (ESAs) have been investigated in small studies in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Erythropoiesis-stimulating agents did not show a clear effect on left ventricular function or clinical outcome, but some studies suggested an increased risk of thromboembolic events.
  
  
  METHODS
  A systematic literature search in MEDLINE was performed, until December 2012. We included randomized clinical trials investigating the effect of ESAs in STEMI patients undergoing primary PCI, with ≥30 days of follow-up. The primary end point was a composite of all-cause mortality, myocardial infarction, and stent thrombosis after PCI. Secondary end point was all-cause mortality.
  
  
  RESULTS
  Individual patient data were obtained from 10 of 11 trials, including 97.3% (1,242/1,277) of all patients randomized to control (n = 600) or to ESAs (n = 642). Baseline characteristics were well balanced between the treatment allocations. Mean follow-up time was 248 (±131) days. The primary end point occurred in 3.5% (20/577) in the control group and in 2.1% (13/610) in the ESA group (hazard ratio for ESAs, 0.63; 95% CI [0.31-1.27]; P = .20). Mortality occurred in 13 (2.3%) in the control group and 5 (0.8%) in the ESA group (hazard ratio for ESAs, 0.38; 95% CI [0.13-1.06]; P = .06).
  
  
  CONCLUSIONS
  Erythropoiesis-stimulating agent administration does not result in an increased risk of adverse cardiac events in STEMI patients undergoing primary PCI. Results of ongoing studies may provide further insight to the potential beneficial clinical effects of ESAs in STEMI patients.
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Marieke L
authors.initials: ML
authors.lastname: Fokkema
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Peter
authors.initials: P
authors.lastname: van der Meer
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.affiliation: Athena Institute, VU University, Amsterdam, the Netherlands.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Belonje
authors.affiliation: Cardiology Department, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Ferrario
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
authors.affiliation: Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York City, NY.
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Katz
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Erik
authors.initials: E
authors.lastname: Lipšic
authors.affiliation: The Hatter Cardiovascular Institute, University College London, London, United Kingdom.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Ludman
authors.affiliation: Deutsches Herzzentrum TU München, Munich, Germany.
authors.forename: Ilka
authors.initials: I
authors.lastname: Ott
authors.affiliation: LUNAM Université, Université Angers, Laboratoire Cardioprotection Remodelage Thrombose, CHU Angers, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Prunier
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Dong-Ju
authors.initials: DJ
authors.lastname: Choi
authors.affiliation: First Department of Internal Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Toba
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.affiliation: Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. Electronic address: a.a.voors@umcg.nl.
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
mesh_terms: D006397:Hematinics / Q000494:pharmacology*; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality; D062645:Percutaneous Coronary Intervention; D018570:Risk Assessment; D013923:Thromboembolism / Q000453:epidemiology; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D006397:Hematinics