Intravenous erythropoietin in patients with ST-segment elevation myocardial infarction: REVEAL: a randomized controlled trial.
Intravenous erythropoietin in patients with ST-segment elevation myocardial infarction: REVEAL: a randomized controlled trial.
复制标题
DOI：
10.1001/jama.2011.592
复制
发表时间：
2011-05-11
影响因子：
120.7
通讯作者：
Harrington, Robert A.
中科院分区：
文献类型：
--
作者：
Najjar, Samer S.;Rao, Sunil V.;Melloni, Chiara;Raman, Subha V.;Povsic, Thomas J.;Melton, Laura;Barsness, Gregory W.;Prather, Kristi;Heitner, John F.;Kilaru, Rakhi;Gruberg, Luis;Hasselblad, Vic;Greenbaum, Adam B.;Patel, Manesh;Kim, Raymond J.;Talan, Mark;Ferrucci, Luigi;Longo, Dan L.;Lakatta, Edward G.;Harrington, Robert A.
急性ST段抬高型心肌梗死（STEMI）是发病率和死亡率的主要原因。在MI的实验模型中，促红细胞生成素减少梗塞面积并改善左心室（LV）功能。评价单次静脉推注依泊苷α治疗STEMI患者的安全性和有效性。一项前瞻性、随机、双盲、安慰剂对照试验，包括剂量递增安全性阶段和单次给药（60，000单位依泊苷α）疗效阶段，涉及222例成功接受经皮冠状动脉介入治疗（PCI）作为主要或补救再灌注策略的STEMI患者。参与者被随机分配到静脉注射依泊苷α或匹配的生理盐水安慰剂治疗再灌注4小时内。研究药物给药后2-6天，通过心脏磁共振（CMR）成像评估的左心室大小，表示为LV质量的百分比。在疗效队列（n=138）中，2-6天（15.8±10.3 vs. 15.0±10.0，P= 0.666）或12±2周（10.6±8.6 vs. 10.4±7.6，P= 0.886）时两组间的梗死面积无差异。在早期（48.2±9.1 vs. 48.9±8.7，P= 0.671）或晚期（52.5±9.3 vs. 52.0±8.8，P= 0.760）时间点，两组间的左心室射血分数也无差异。在对年龄≥70岁的患者（n=21）进行的预先规定的分析中，第一周内epoadipa组的平均梗死面积大于安慰剂组（19.9±9.9 vs.11.7±7.2，P= 0.026）。接受依泊苷α治疗的患者死亡、心肌梗死、卒中或支架内血栓形成复合终点的发生率较高（4.0% vs. 0.0%，P= 0.042），严重不良事件的发生率较高（20.0% vs. 10.3%，P= 0.052）。在直接或补救PCI成功再灌注的ST段抬高型心肌梗死患者中，单次静脉推注依泊苷α不能减少梗死面积，并且与更高的不良心血管事件发生率相关。此外，它可能与老年患者的梗死面积增加有关。clinicaltrials.gov标识符NCT 00378352。
Acute ST-segment elevation myocardial infarction (STEMI) is a leading cause of morbidity and mortality. In experimental models of MI, erythropoietin reduces infarct size and improves left ventricular (LV) function. To evaluate the safety and efficacy of a single intravenous bolus of epoetin alfa in patients with STEMI. Prospective, randomized, double-blind, placebo-controlled trial with a dose-escalation safety phase and a single-dose (60,000 units of epoetin alfa) efficacy phase involving 222 patients with STEMI who underwent successful percutaneous coronary intervention (PCI) as a primary or rescue reperfusion strategy. Participants were randomly assigned to treatment with intravenous epoetin alfa or matching saline placebo administered within 4 hours of reperfusion. Infarct size, expressed as a percentage of LV mass, assessed by cardiac magnetic resonance (CMR) imaging 2–6 days after study medication administration. In the efficacy cohort (n=138), infarct size did not differ between groups at either 2–6 days (15.8±10.3 vs. 15.0±10.0, P=.666) or 12±2 weeks (10.6±8.6 vs. 10.4±7.6, P=.886). Left ventricular ejection fraction also did not differ between groups at either the early (48.2±9.1 vs. 48.9±8.7, P=.671) or late (52.5±9.3 vs. 52.0±8.8, P=.760) timepoints. In pre-specified analyses of patients aged ≥70 years (n=21), mean infarct size within the first week was larger in the epoetin alfa arm than in the placebo group (19.9±9.9 vs.11.7±7.2, P=.026). Patients who received epoetin alfa had a higher incidence of the composite endpoint of death, myocardial infarction, stroke, or stent thrombosis (4.0% vs. 0.0%, P=.042), and a higher incidence of serious adverse events (20.0% vs. 10.3%, P=.052). In STEMI patients successfully reperfused with primary or rescue PCI, a single intravenous bolus of epoetin alfa did not reduce infarct size and was associated with higher rates of adverse cardiovascular events. Furthermore, it may be associated with increased infarct size in older patients. clinicaltrials.gov identifier NCT00378352.
登录
查看更多内容
影响因子：
3.4
作者：
Lipsic, Erik;van der Meer, Peter;van Veldhuisen, Dirk J.
通讯作者：
van Veldhuisen, Dirk J.
影响因子：
15.9
作者：
Parsa, CJ;Matsumoto, A;Koch, WJ
通讯作者：
Koch, WJ
影响因子：
24
作者：
Lipsic, Erik;Schoemaker, Regien G.;van Gilst, Wiek H.
通讯作者：
van Gilst, Wiek H.
影响因子：
37.8
作者：
PFEFFER, MA;BRAUNWALD, E
通讯作者：
BRAUNWALD, E
DOI：
10.1161/circinterventions.109.904425
发表时间：
2010-10-01
影响因子：
5.6
作者：
Ott, Ilka;Schulz, Stefanie;Schoemig, Albert
通讯作者：
Schoemig, Albert