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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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