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Voors, A.A.; Belonje, A.M.S.; Zijlstra, F.; Hillege, H.L.; Anker, S.D.; Slart, R.H.J.A.; ... ; HEBE III Investigators (2010)

A single dose of erythropoietin in ST-elevation myocardial infarction

Article / Letter to editor
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). 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...Show moreCardioprotective 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). 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). 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=2Show less
ST-elevation myocardial infarction Erythropoietin Left ventricular function Cardiovascular events Infarct size improves cardiac-function recombinant-human-erythropoietin ischemia-reperfusion injury heart-failure endogenous erythropoietin darbepoetin-alpha neovascularization trial ischemia/reperfusion feasibility
All authors
Voors, A.A.; Belonje, A.M.S.; Zijlstra, F.; Hillege, H.L.; Anker, S.D.; Slart, R.H.J.A.; Tio, R.A.; Van't Hof, A.; Jukema, J.W.; Peels, H.O.J.; Henriques, J.P.S.; Berg, J.M. ten; Vos, J.; Gilst, W.H. van; Veldhuisen, D.J. van; HEBE III Investigators
Date
2010-11-30
Journal
European Heart Journal
Volume
31
Issue
21
Pages
2593 - 2600
DOI
doi:10.1093/eurheartj/ehq304