Biology Reference
In-Depth Information
In the study conducted in Dubai (
56, 57
) 236 patients with
STEMI, admitted less than 6 h after onset of chest pain were sub-
jected to thrombolytic treatment. 115 of them were additionally
treated with intravenous injection of 30,000 of epoetin-beta prior
to thrombolytic therapy. The primary end-point was an enzymati-
cally estimated MI size, secondary end-point—echocardiographic
measurements at the time of discharge. There were no differences
between groups at any of end-point parameters.
Results of a small (16 control, 20 EPO) prospective random-
ized, single-blind, multicentered trial (EPO/AMI-1) conducted in
Japan were reported in 2010 (
58, 59
). AMI patients with
ST-segment elevation were admitted within 24 h after onset of
symptoms. They undergo successful PCI and thrombolysis. EPO,
12,000 IU (epoetin-beta) was given within 24 h after PCI. LVEF
measured via photon emission CT 4 days after PCI was not differ-
ent between groups, but at 6-month follow-up LVEF was
significantly higher in EPO treated group. Nevertheless, the LVEF
increments between 4 days and 6 months measurements were not
different between groups.
Combined efforts of clinical groups in the Netherlands and
Germany resulted in prospective, randomized, blinded end-points
study, HEBE III (
60, 61
). Patients with first ST-segment elevation
MI were hospitalized within 12-24 h of symptom onset and ran-
domized after successful PCI. A single bolus of 60,000 IU of epo-
etin-alfa or placebo was injected intravenously within 3 h after PCI.
MI size measured enzymatically was slightly (but statistically not
significant) reduced. However, LVEF 6 weeks after MI was not
different between groups.
In the German clinical trial REVIVAL-3 (
62
) patients diag-
nosed with ST-segment elevation MI were undergoing primary
PCI within 24 h of symptom onset. Epoetin-beta (33,300 IU/kg)
was given immediately after PCI. Additional doses were given 24
and 48 h later. Cardiac MRI was performed 5 days and 6 months
after MI. There were no differences between EPO treated and
control groups in any measured parameter at 5 days or 6 months.
The changes of MI size and EF between two groups were also
similar.
Japanese clinical trial, EPOC-AMI (
63
) was similar in design
with REVIVAL-3, but EPO dose was lower. Patients with
SR-segment elevated MI were subjected to a primary PCI within
12 h of symptom onset and treated with 6,000 IU of epoetin-beta
immediately after that. This dose was repeated on day 2 and 4. MI
size was measured via Tc
99m
-tetrofosmin SPECT 4 days and 6
months after PCI. There were no differences between treated and
untreated groups at either measurement. However, comparison of
these two measurements showed the reduction of MI and some
increase of EF with time in EPO-treated group, while changes in
untreated group were not statistically significant.
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