Erythropoietin in Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention A Randomized, Double-Blind Trial
Erythropoietin in Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention A Randomized, Double-Blind Trial
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DOI：
10.1161/circinterventions.109.904425
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发表时间：
2010-10-01
影响因子：
5.6
通讯作者：
Schoemig, Albert
中科院分区：
文献类型：
--
作者：
Ott, Ilka;Schulz, Stefanie;Schoemig, Albert
背景：促红细胞生成素在心肌梗死实验模型中改善心肌功能。本研究的目的是确定促红细胞生成素在急性st段抬高型心肌梗死患者中的价值。方法和结果：这项随机、双盲研究纳入了138例急性st段抬高型心肌梗死患者，并接受了初步经皮冠状动脉介入治疗。患者被随机分配在经皮冠状动脉介入治疗后立即和24小时和48小时接受epoetin- β （3.33 × 104 U, n = 68）或安慰剂（n = 70）。主要终点是6个月后用MRI测量左心室射血分数。其他终点包括5天和6个月时的梗死面积。临床不良事件（死亡、复发性心肌梗死、卒中和梗死相关动脉血运重建）分别在30天和6个月时进行调查。6个月随访时，促红细胞生成素组左心室射血分数为52.0 +/- 9.1%，而安慰剂组为51.8 +/- 9.3% （P = 0.92）。经皮冠状动脉介入治疗5 d后，促红细胞生成素组左心室射血分数为49.4 +/- 8.0%，安慰剂组为50.8 +/- 7.3% (P = 0.32)；梗死面积（P = 0.27）。促红细胞生成素组6个月累计死亡、心肌梗死复发、卒中或靶血管重建术发生率为13.2%，安慰剂组为5.7%（风险比2.36；95%可信区间0.73 ~ 7.66;P = 0.15）。结论：急性st段抬高型心肌梗死患者经皮冠状动脉介入治疗后，促红细胞生成素治疗不能改善左室射血分数或减少梗死面积，但可能增加临床不良事件。
Background-Erythropoietin improves myocardial function in experimental models of myocardial infarction. The aim of the present study was to determine the value of erythropoietin in patients with acute ST-elevation myocardial infarction.Methods and Results-This randomized, double-blind study included 138 patients admitted with acute ST-elevation myocardial infarction and treated with primary percutaneous coronary intervention. Patients were randomly assigned to receive epoetin-beta (3.33x104 U, n = 68) or placebo (n = 70) immediately and at 24 and 48 hours after percutaneous coronary intervention. The primary end point was left ventricular ejection fraction after 6 months measured by MRI. Other end points included infarct size at 5 days and 6 months. Clinical adverse events (death, recurrent myocardial infarction, stroke, and infarct-related artery revascularization) were investigated at 30 days and 6 months. Left ventricular ejection fraction at 6-month follow-up was 52.0 +/- 9.1% in the erythropoietin group compared with 51.8 +/- 9.3% in the placebo group (P = 0.92). Five days after percutaneous coronary intervention, left ventricular ejection fraction was 49.4 +/- 8.0% in the erythropoietin group and 50.8 +/- 7.3% in the placebo group (P = 0.32); infarct size was (P = 0.27). The cumulative 6-month incidence of death, recurrent myocardial infarction, stroke or target vessel revascularization was 13.2% in the erythropoietin group and 5.7% in the placebo group (hazard ratio, 2.36; 95% confidence interval, 0.73 to 7.66; P = 0.15).Conclusions-In patients with acute ST-elevation myocardial infarction treated with primary percutaneous coronary intervention, erythropoietin treatment did not improve left ventricular ejection fraction or reduce infarct size but may increase clinical adverse events.