Effect of erythropoiesis-stimulating agents in acute ST-segment elevation myocardial infarction: a systematic review

Li, Juan; Xu, Haolin; Gao, Qian; Wen, Yanting

doi:10.1007/s00228-011-1160-y

Cited by 14 publications

(7 citation statements)

References 33 publications

(60 reference statements)

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“…There was no significant benefit of ESAs on infarct size in a meta-analyses of patients with acute ST-segment elevation myocardial infarction [64, 65], and no effect on nonfatal heart related events in a meta-analysis of ESA-treated patients with heart failure [66]. There was also no difference in a meta-analysis of retinopathy of prematurity in infants treated with ESAs [67].…”

Section: Discussionmentioning

confidence: 99%

Erythropoiesis stimulating agents and reno-protection: a meta-analysis

2017

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BackgroundErythropoiesis stimulating agents (ESAs) were proposed to enhance survival of renal tissues through direct effects via activation of EPO receptors on renal cells resulting in reduced cell apoptosis, or indirect effects via increased oxygen delivery due to increased numbers of Hb containing red blood cells. Thus through several mechanisms there may be benefit of ESA administration on kidney disease progression and kidney function in renal patients. However conflicting ESA reno-protection outcomes have been reported in both pre-clinical animal studies and human clinical trials. To better understand the potential beneficial effects of ESAs on renal-patients, meta-analyses of clinical trials is needed.MethodsLiterature searches and manual searches of references lists from published studies were performed. Controlled trials that included ESA treatment on renal patients with relevant renal endpoints were selected.ResultsThirty two ESA controlled trials in 3 categories of intervention were identified. These included 7 trials with patients who had a high likelihood of AKI, 7 trials with kidney transplant patients and 18 anemia correction trials with chronic kidney disease (predialysis) patients. There was a trend toward improvement in renal outcomes in the ESA treated arm of AKI and transplant trials, but none reached statistical significance. In 12 of the anemia correction trials, meta-analyses showed no difference in renal outcomes with the anemia correction but both arms received some ESA treatment making it difficult to assess effects of ESA treatment alone. However, in 6 trials the low Hb arm received no ESAs and meta-analysis also showed no difference in renal outcomes, consistent with no benefit of ESA/ Hb increase.ConclusionsMost ESA trials were small with modest event rates. While trends tended to favor the ESA treatment arm, these meta-analyses showed no reduction of incidence of AKI, no reduction in DGF or improvement in 1-year graft survival after renal transplantation and no significant delay in progression of CKD. These results do not support significant clinical reno-protection by ESAs.

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Section: Discussionmentioning

confidence: 99%

Erythropoiesis stimulating agents and reno-protection: a meta-analysis

2017

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“…In previous studies, using both EPO and darbepoetin revealed that erythropoietin-stimulating agents with a higher first dose (>20,000 IU) or total dose (≥30,000 IU) improved LV ejection fraction more significantly when compared with that of lower doses (<20,000 IU). 21 High-dose EPO was superior to placebo, statistically improving LV ejection fraction by 1.02% and LV end systolic volume by −4.61 mL in patients with acute STEMI, and it was generally well tolerated. The adverse effects reported in patients receiving high-dose EPO were essentially consistent with those in the placebo group.…”

Section: Discussionmentioning

confidence: 87%

Erythropoietin Reduces Post-PCI Arrhythmias in Patients With ST-elevation Myocardial Infarction

Gholamzadeh

Mohammadpour

Vahabzadeh

et al. 2015

Journal of Cardiovascular Pharmacology

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Background:Arrhythmia is the foremost cause of sudden death after myocardial infarction (MI). Animal models have recently shown that erythropoietin (EPO) can reduce the incidence of arrhythmia after MI.Methods:We investigated the effects of administrating 33,000 IU EPO on the occurrence of post-MI arrhythmia in 40 patients with ST-elevation MI who were randomly assigned in either EPO or placebo groups. Arrhythmias were blindly documented using full 12-lead configuration during 24 hours after percutaneous coronary intervention (PCI) by a cardiologist. Afterward, CK-MB, hematologic, and hemodynamic data were examined within 2 weeks after MI.Results:A comparison made between the 2 groups showed significant differences in the incidence of arrhythmias (20% in EPO group and 35% in placebo group, P = 0.043). However, no significant differences in type of arrhythmias were observed between the groups. There was no significant difference between levels of CK-MB in the 2 groups during 24 hours (P = 0.186). Hematologic and hemodynamic data showed no significant changes 2 weeks after PCI.Conclusion:High-dose administration of EPO in patients with ST-elevation MI who have been treated by primary PCI and standard antiplatelet therapy reduces the occurrence of arrhythmias. For clinical interpretation of the results, further well-designed trials are required.

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“…The dose of darbepoetin-α was chosen based on previous preclinical and clinical studies. [17][18][19] Thrombus aspiration or drug-eluting stent implantation was performed at the physician's discretion. TIMI flow grade and myocardial blush grade (MBG) were related with the prognosis of STEMI patients.…”

Section: Study Design and Populationmentioning

confidence: 99%

“…However, a meta-analysis revealed that a higher dose of r-HuEPO (> 30,000 IU of epoetin-α) improved LVEF more significantly compared with the lower dose group (< 20,000 IU). 18) Accordingly, a high-dose of r-HuEPO may be more suitable for reducing reperfusion injury. Effect of intracoronary administration of erythropoietin in clinical studies: Intracoronary bolus administration of drugs results in higher concentration levels in the ischemic myocardium and local coronary bed.…”

Section: Efficacy Of Intracoronary Darbepoetin-α In Stemimentioning

confidence: 99%

Efficacy of IntraCoronary Erythropoietin Delivery BEfore Reperfusion-Gauging Infarct Size in Patients with Acute ST-segment Elevation Myocardial Infarction (ICEBERG)

Seo

Suh

et al. 2019

Int. Heart J.

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Previous clinical studies have shown inconsistent results regarding the effect of erythropoietin in STsegment elevation myocardial infarction (STEMI). This study investigated whether directed intracoronary infusion of darbepoetin-α into ischemic myocardium before reperfusion would reduce infarct size or post-infarct remodeling in STEMI patients. Eighty STEMI patients received one of the following treatments simultaneously with the first balloon inflation: intracoronary darbepoetin-α 300 μg (n = 40) or saline (n = 40), administered via the over-the-wire balloon system. The primary endpoint was infarct size estimated by serial cardiac enzyme levels after procedure. The secondary endpoints were (1) infarct size and proportion of salvaged myocardium measured with cardiac magnetic resonance (CMR) at baseline; (2) post-infarct remodeling (PIR), defined as an increase in left ventricular end-diastolic volume more than 20% at 4 months compared to the baseline on CMR; and (3) composite cardiovascular endpoints assessed at 4 months. The peak CK-MB [median 270.0 (interquartile range 139.8-356.3) versus 231.5 (131.0-408.5) ng/mL, P = 0.55] and troponin-I [128.5 (63.5-227.8) versus 109.0 (43.8-220.0) ng/mL, P = 0.52)] did not differ between the darbepoetin-α and control group. Fifty-seven patients completed the baseline and 4-month follow-up CMR. There were no differences in infarct size [30.6 (18.1-49.8) versus 31.5 (22.5-47.3) cm 3 , P = 0.91), proportion of salvaged myocardium [26.7% (15.9-42.6%) versus 35.8% (22.4-48.8%), P = 0.12) or PIR (8.0% versus 6.7%, P = 0.62) between the two groups. Composite cardiovascular outcomes did not differ between the two groups. In conclusion, administration of intracoronary darbepoetin-α before reperfusion did not reduce infarct size or post-infarct remodeling in STEMI patients.

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Effect of erythropoiesis-stimulating agents in acute ST-segment elevation myocardial infarction: a systematic review

Cited by 14 publications

References 33 publications

Erythropoiesis stimulating agents and reno-protection: a meta-analysis

Erythropoiesis stimulating agents and reno-protection: a meta-analysis

Erythropoietin Reduces Post-PCI Arrhythmias in Patients With ST-elevation Myocardial Infarction

Efficacy of IntraCoronary Erythropoietin Delivery BEfore Reperfusion-Gauging Infarct Size in Patients with Acute ST-segment Elevation Myocardial Infarction (ICEBERG)

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