Single high-dose erythropoietin administration immediately after reperfusion in patients with ST-segment elevation myocardial infarction: results of the Erythropoietin in Myocardial Infarction Trial

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• 作者：Fabrice Prunier ; MD ; PhD^a ; ^b ; ^{FaPrunier@chu-angers.fr} ; Loï ; c Biè ; re ; MD^a ; Martine Gilard ; MD ; PhD^c ; Jacques Boschat ; MD^c ; Fré ; dé ; ric Mouquet ; MD ; PhD^d ; Jean-Jacques Bauchart ; MD^d ; Bernard Charbonnier ; MD^e ; Olivier Gené ; e ; MD^e ; Patrice Gué ; rin ; MD ; PhD^f ; ^b ; Karine Warin-Fresse ; MD^f ; ^b ; Eric Durand ; MD^g ; Antoine Lafont ; MD ; PhD^g ; Luc Christiaens ; MD ; PhD^h ; Wissam Abi-Khalil ; MD^a ; Sté ; phane Delé ; pine ; MD^a ; Thomas Benard ; MD^a ; Alain Furber ; MD ; PhD^a ; ^b
• 刊名：American Heart Journal
• 出版年：2012
• 出版时间：February 2012
• 年：2012
• 卷：163
• 期：2
• 页码：200-207.e1
• 全文大小：207 K

文摘

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Background

Preclinical studies and pilot clinical trials have shown that high-dose erythropoietin (EPO) reduces infarct size in acute myocardial infarction. We investigated whether a single high-dose of EPO administered immediately after reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) would limit infarct size.

Methods

A total of 110 patients undergoing successful primary coronary intervention for a first STEMI was randomized to receive standard care either alone (n = 57) or combined with intravenous administration of 1,000 U/kg of epoetin ¦Â immediately after reperfusion (n = 53). The primary end point was infarct size assessed by gadolinium-enhanced cardiac magnetic resonance after 3 months. Secondary end points included left ventricular (LV) volume and function at 5-day and 3-month follow-up, incidence of microvascular obstruction (MVO), and safety.

Results

Erythropoietin significantly decreased the incidence of MVO (43.4 % vs 65.3 % in the control group, P = .03) and reduced LV volume, mass, and function impairment at 5-day follow-up (all P < .05). After 3 months, median infarct size (interquartile range) was 17.5 g (7.6-26.1 g) in the EPO group and 16.0 g (9.4-28.2 g) in the control group (P = .64); LV mass, volume, and function were not significantly different between the 2 groups. The same number of major adverse cardiac events occurred in both groups.

Conclusions

Single high-dose EPO administered immediately after successful reperfusion in patients with STEMI did not reduce infarct size at 3-month follow-up. However, this regimen decreased the incidence of MVO and was associated with transient favorable effects on LV volume and function.