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A single dose of erythropoietin in ST-elevation myocardial infarction

Adriaan A. Voors, Anne M.S. Belonje, Felix Zijlstra, Hans L. Hillege, Stefan D. Anker, Riemer H.J.A. Slart, René A. Tio, Arnoud van ‘t Hof, J. Wouter Jukema, Hans Otto J. Peels, José P.S. Henriques, Jurriën M. ten Berg, Jeroen Vos, Wiek H. van Gilst, Dirk J. van Veldhuisen
DOI: http://dx.doi.org/10.1093/eurheartj/ehq304 First published online: 29 August 2010

Abstract

Aims 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 000IU 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. Clinical Trial Registration Information: NCT00449488; http://www.clinicaltrials.gov/ct2/show/NCT00449488?term=voors&rank=2.

  • ST-elevation myocardial infarction
  • Erythropoietin
  • Left ventricular function
  • Cardiovascular events
  • Infarct size
    • Received June 21, 2010.
    • Revision received July 29, 2010.
    • Accepted August 4, 2010.
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