Erythropoietin Prevention Trial of Coronary Restenosis and Cardiac Remodeling After ST-Elevated Acute Myocardial Infarction (EPOC-AMI) - A Pilot, Randomized, Placebo-Controlled Study

被引:71
作者
Taniguchi, Norimasa [2 ]
Nakamura, Takeshi
Sawada, Takahisa
Matsubara, Kinya [3 ]
Furukawa, Keizo [3 ]
Hadase, Mitsuyoshi [4 ]
Nakahara, Yoshifumi [4 ]
Nakamura, Takashi [1 ,4 ]
Matsubara, Hiroaki
机构
[1] Kyoto Prefectural Univ Med, Dept Cardiovasc Med, Kamigyo Ku, Kyoto 6028566, Japan
[2] Sakurakai Takahashi Hosp, Dept Cardiol, Kobe, Hyogo, Japan
[3] Kyoto City Hosp, Dept Cardiol, Kyoto, Japan
[4] Saiseikai Shigaken Hosp, Dept Cardiol, Ritto, Japan
关键词
Acute myocardial infarction; Cardiac function; Erythropoietin; LEFT-VENTRICULAR FUNCTION; ANALOG DARBEPOETIN-ALPHA; HEART-FAILURE; ANGIOPLASTY; ACTIVATION; MICE; AKT; EXPRESSION; SURVIVAL; RECEPTOR;
D O I
10.1253/circj.CJ-10-0267
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Erythropoietin (EPO) enhances re-endothelialization and anti-apoptotic action. Larger clinical studies to examine the effects of high-dose EPO are in progress in patients with acute myocardial infarction (AMI). Methods and Results: The aim of this multi-center pilot study was to investigate the effect of low-dose EPO' (6,000 IU during percutaneous coronary intervention (PCI), 24h and 48h) in 35 patients with a first ST-elevated AMI undergoing PCI who was randomly assigned to EPO or placebo (saline) treatment. Neointimal volume, cardiac function and infarct size were examined in the acute phase and 6 months later (ClinicalTrials.gov identifier: NCT00423020). No significant regression in in-stent neointimal volume was observed, whereas left ventricular (LV) ejection fraction was significantly improved (49.2% to 55.7%, P=0.003) and LV end-systolic volume was decreased in the EPO group (47.7 ml to 39.0 ml, P=0.036). LV end-diastolic volume tended to be reduced from 90.2% to 84.5% (P=0.159), whereas in the control group it was inversely increased (91.7% to 93.7%, P=0.385). Infarction sizes were significantly reduced by 38.5% (P=0.003) but not in the control group (23.7%, P=0.051). Hemoglobin, peak creatine kinase values, and CD34(+)/CD133(+)/CD45(dim) endothelial progenitors showed no significant changes. No adverse events were observed during study periods. Conclusions: This is a first study demonstrating that short-term low-dose' EPO to PCI-treated AMI patients did not prevent neointimal hyperplasia but rather improved cardiac function and infarct size without any clinical adverse effects. (Circ J 2010; 74: 2365-2371)
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页码:2365 / 2371
页数:7
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