A single dose of erythropoietin in ST-elevation myocardial infarction
A single dose of erythropoietin in ST-elevation myocardial infarction
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DOI：
10.1093/eurheartj/ehq304
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发表时间：
2010-11-01
影响因子：
39.3
通讯作者：
van Veldhuisen, Dirk J.
中科院分区：
文献类型：
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作者：
Voors, Adriaan A.;Belonje, Anne M. S.;van Veldhuisen, Dirk J.
促红细胞生成素（EPO）的抗氧化保护作用已在实验和较小的临床研究中显示。我们进行了一项前瞻性、多中心、随机试验，以评估ST段抬高型心肌梗死（STEMI）直接冠状动脉介入治疗（PCI）后单次大剂量EPO的效果。首次STEMI成功PCI的患者随机接受标准医疗护理，或在PCI后3小时内联合单次推注60 000 IU静脉注射EPO。主要终点为6周后通过平面放射性核素心室造影评估的左心室射血分数（LVEF）。预先规定的次要终点包括酶促梗死面积和主要不良心血管事件。共纳入529例患者（EPO组n = 263，对照组n = 266）。在基线（EPO给药前），各组的所有相关特征均匹配良好。平均6.5（+/- 2.0）周后，EPO组LVEF为0.53（+/- 0.10），对照组为0.52（+/- 0.11）（P = 0.41）。EPO组72 h后肌酐激酶曲线下面积中位数（四分位距）为50 136（28 212-76 664）U/L/72 h，对照组为53 510（33 973-90 486）U/L/72 h（P = 0.058）。对照组的主要不良心脏事件发生率高于EPO组（19例vs.8例; P = 0.032），STEMI患者成功PCI后单次大剂量EPO治疗6周后未改善LVEF。然而，EPO的使用与较少的主要不良心血管事件和有利的临床安全性特征相关。临床试验注册信息：NCT 00449488; http：www.clinicaltrials.gov/ct2/show/NCT00449488? term=voors&rank=2
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 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=2