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HEBE III: A single dose of erythropoietin in ST-elevation myocardial infarction

Acute Coronary Syndromes

Adriaan Voors, FESC
Presenter | see Discussant report Webcasts become available 12h after the presentation
Voors, Adriaan
Open presentation slides

List of Authors:
Adriaan A. Voors, Anne M.S. Belonje, Felix Zijlstra, Hans L. Hillege, Stefan D. Anker, Riemer H.J.A. Slart, Rene´ A. Tio, Arnoud van ‘t Hof, J. Wouter Jukema, Hans Otto J. Peels, Jose´ P.S. Henriques, Jurrien M. ten Berg, Jeroen Vos, Wiek H. van Gilst, and Dirk J. van Veldhuisen, on behalf of the HEBE III investigators


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).

Methods and results:
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 60 000 IU 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 an 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

Piotr Ponikowski, FESC
Discussant | see Presenter abstract Webcasts become available 12h after the presentation
Ponikowski, Piotr
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Contemporary management of patients with acute myocardial infarction (AMI) is based on the widely established concept of opening the infarct-related artery in order to achieve early reperfusion and salvage the myocardium. Although the introduction of thrombolytic therapy and subsequently percutanoeus coronary intervention (PCI) dramatically improved the outcome in AMI, many patients who survive an acute phase of AMI still demonstrate extensive, irreversible damage of the myocardium and ultimately develop cardiac remodelling and heart failure (HF) which unfavourably affect mortality and morbidity.1,2 Thus, prevention or attenuation of remodelling is considered an important therapeutic goal during both the early and later stages after AMI. The size of the infarcted area correlates with resultant haemodynamic derangements and neurohormonal activation, and is a key predictor of left ventricle (LV) remodelling and development of HF.1 There is a constant interest in and search for therapies limiting infarct size, which can be an adjuvant to early reperfusion strategies.

AMI triggers an increase in the blood levels of inflammatory and haematopoietic cytokines capable of mobilizing numerous types of stem/progenitor cells.3 It can be a self-repair mechanism in which progenitor/stem cells can contribute to myocardial and vascular regeneration after acute injury. Among these cytokines, erythropoietin (EPO), a hormone involved in the regulation of erythropoiesis, may play an important role. Apart from being a stimulus for progenitor cell mobilization,4 EPO itself exerts potent protective effects within the cardiovascular system,5 thus carrying the potential to be a promising agent for the treatment of AMI.
Full text in ESC HOT LINE COMMENTARY published in European Heart Journal (doi:10.1093/eurheartj/ehq307)


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Hot Line I - Heart failure and left ventricular dysfunction
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.