Featured Research

from universities, journals, and other organizations

Administration of erythropoietin to patients with heart attack who undergo coronary intervention procedures

Date:
May 10, 2011
Source:
JAMA and Archives Journals
Summary:
Intravenous administration of epoetin alfa, a product that stimulates red blood cell production, to patients with heart attack who were undergoing percutaneous coronary intervention (PCI; procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries), did not provide reduction in the size of the heart muscle involved and was associated with higher rates of adverse cardiovascular events, according to a new study.

Intravenous administration of epoetin alfa, a product that stimulates red blood cell production, to patients with heart attack who were undergoing percutaneous coronary intervention (PCI; procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries), did not provide reduction in the size of the heart muscle involved and was associated with higher rates of adverse cardiovascular events, according to a study in the May 11 issue of JAMA.

Patients who survive ST-segment elevation myocardial infarction (STEMI; a certain pattern on an electrocardiogram following a heart attack) are at risk for developing infarct (an area of tissue death due to a local lack of oxygen) expansion and left ventricular (LV) remodeling (topographical and functional changes). Both are strongly associated with heart failure and death, according to background information in the article. There are several risk factors for infarct expansion and LV remodeling, including infarct size. "Given the global burden of ischemic heart disease and heart failure, therapies that limit infarct size and attenuate or reverse LV remodeling are needed," the authors write. Preclinical studies have shown that erythropoietin, a glycoprotein hormone, plays a cardioprotective role in various experimental models, and was associated with significant reductions in infarct size and improvements in LV function.

Samer S. Najjar, M.D., of the National Institutes of Health, Baltimore, and colleagues evaluated the safety and effect on infarct size of a single intravenous dose of recombinant human erythropoietin (epoetin alfa) in patients with STEMI who had undergone PCI. The randomized, placebo-controlled trial (the REVEAL trial) was conducted at 28 U.S. sites between October 2006 and February 2010 and included 222 patients. Participants were randomly assigned to treatment with intravenous epoetin alfa or matching saline placebo administered within 4 hours of reperfusion. One of the primary outcome measures of the study was infarct size, expressed as percentage of LV mass, assessed by cardiac magnetic resonance (CMR) imaging performed 2 to 6 days after study medication administration and again 12 (plus or minus 2) weeks later.

The researchers found that in the efficacy group, the infarct size did not differ between groups on either the first CMR scan (n = 136; 15.8 percent LV mass for the epoetin alfa group vs. 15.0 percent LV mass for the placebo group) or on the second CMR scan (n = 124; 10.6 percent LV mass vs. 10.4 percent LV mass, respectively). In the safety cohort, of the 125 patients who received epoetin alfa, the composite outcome of death, heart attack, stroke, or stent thrombosis (blood clot) occurred in 5 (4.0 percent) but in none of the 97 who received placebo.

In a prespecified analysis of patients age 70 years or older (n = 21), the average infarct size within the first week was larger in the epoetin alfa group (19.9 percent LV mass) than in the placebo group (11.7 percent LV mass).

"Although this concerning finding should be interpreted with caution due to the small number of older patients enrolled in the REVEAL trial and the lack of multiplicity adjustment in the analyses, it suggests the need for added vigilance before enrolling older patients in any future trial evaluating erythropoietin in the setting of myocardial infarction," the authors write.

Editorial: Evaluation of Agents to Reduce Infarct Size

Deepak L. Bhatt, M.D., M.P.H., of the VA Boston Healthcare System, Boston, comments on the findings of this study in an accompanying editorial.

"The totality of evidence strongly suggests that this class of medication [erythropoietin] has cardiovascular risk, most likely to manifest in higher-risk individuals. Until compelling data become available to support routine use of these agents in patients with anemia, it would be prudent to minimize their use, especially for patients at high risk for cardiovascular disease or with an acute ischemic syndrome. For situations in which use of these agents seems necessary such as when patients need frequent transfusions, it will be important to educate patients about the potential risks of ischemia so they are aware of the signs and symptoms and know to seek help should an ischemic or thrombotic syndrome develop."


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal References:

  1. S. S. Najjar, S. V. Rao, C. Melloni, S. V. Raman, T. J. Povsic, L. Melton, G. W. Barsness, K. Prather, J. F. Heitner, R. Kilaru, L. Gruberg, V. Hasselblad, A. B. Greenbaum, M. Patel, R. J. Kim, M. Talan, L. Ferrucci, D. L. Longo, E. G. Lakatta, R. A. Harrington. Intravenous Erythropoietin in Patients With ST-Segment Elevation Myocardial Infarction: REVEAL: A Randomized Controlled Trial. JAMA: The Journal of the American Medical Association, 2011; 305 (18): 1863 DOI: 10.1001/jama.2011.592
  2. D. L. Bhatt. Evaluation of Agents to Reduce Infarct Size: It Can Be Quite REVEALing. JAMA: The Journal of the American Medical Association, 2011; 305 (18): 1908 DOI: 10.1001/jama.2011.600

Cite This Page:

JAMA and Archives Journals. "Administration of erythropoietin to patients with heart attack who undergo coronary intervention procedures." ScienceDaily. ScienceDaily, 10 May 2011. <www.sciencedaily.com/releases/2011/05/110510161801.htm>.
JAMA and Archives Journals. (2011, May 10). Administration of erythropoietin to patients with heart attack who undergo coronary intervention procedures. ScienceDaily. Retrieved October 23, 2014 from www.sciencedaily.com/releases/2011/05/110510161801.htm
JAMA and Archives Journals. "Administration of erythropoietin to patients with heart attack who undergo coronary intervention procedures." ScienceDaily. www.sciencedaily.com/releases/2011/05/110510161801.htm (accessed October 23, 2014).

Share This



More Health & Medicine News

Thursday, October 23, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Orthodontist Mom Jennifer Salzer on the Best Time for Braces

Orthodontist Mom Jennifer Salzer on the Best Time for Braces

Working Mother (Oct. 22, 2014) Is your child ready? Video provided by Working Mother
Powered by NewsLook.com
U.S. Issues Ebola Travel Restrictions, Are Visa Bans Next?

U.S. Issues Ebola Travel Restrictions, Are Visa Bans Next?

Newsy (Oct. 22, 2014) Now that the U.S. is restricting travel from West Africa, some are dropping questions about a travel ban and instead asking about visa bans. Video provided by Newsy
Powered by NewsLook.com
US to Track Everyone Coming from Ebola Nations

US to Track Everyone Coming from Ebola Nations

AP (Oct. 22, 2014) Stepping up their vigilance against Ebola, federal authorities said Wednesday that everyone traveling into the US from Ebola-stricken nations will be monitored for symptoms for 21 days. (Oct. 22) Video provided by AP
Powered by NewsLook.com
Doctors Help Paralysed Man Walk Again, Patient in Disbelief

Doctors Help Paralysed Man Walk Again, Patient in Disbelief

AFP (Oct. 22, 2014) Polish doctors describe how they helped a paralysed man walk again, with the patient in disbelief at the return of sensation to his legs. Duration: 1:04 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins