Seo Won-Woo, Suh Jung-Won, Oh Il-Young, Yoon Chang-Hwan, Cho Young-Seok, Youn Tae-Jin, Chae In-Ho, Choi Dong-Ju
Division of Cardiology, Department of Internal Medicine, Kangdong Sacred Heart Hospital.
Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Center, Seoul National University Bundang Hospital.
Int Heart J. 2019 Mar 20;60(2):255-263. doi: 10.1536/ihj.18-035. Epub 2019 Feb 22.
Previous clinical studies have shown inconsistent results regarding the effect of erythropoietin in ST-segment 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, 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.
先前的临床研究表明，促红细胞生成素在ST段抬高型心肌梗死（STEMI）中的作用结果并不一致。本研究调查了在再灌注前向缺血心肌内直接冠状动脉输注达贝泊汀-α是否会减小STEMI患者的梗死面积或减轻梗死后重塑。80例STEMI患者在首次球囊扩张时同时接受以下治疗之一：通过钢丝球囊系统冠状动脉内注射300μg达贝泊汀-α（n = 40）或生理盐水（n = 40）。主要终点是术后通过系列心肌酶水平估计的梗死面积。次要终点包括：（1）基线时用心脏磁共振（CMR）测量的梗死面积和挽救心肌的比例；（2）梗死后重塑（PIR），定义为与CMR基线相比，4个月时左心室舒张末期容积增加超过20%；（3）4个月时评估的复合心血管终点。达贝泊汀-α组和对照组之间的肌酸激酶同工酶峰值[中位数270.0（四分位间距139.8 - 356.3）对231.5（131.0 - 408.5）ng/mL，P = 0.55]和肌钙蛋白-I[128.5（63.5 - 227.8）对109.0（43.8 - 220.0）ng/mL，P = 0.52]无差异。57例患者完成了基线和4个月的随访CMR。两组之间的梗死面积[30.6（18.1 - 49.8）对31.5（22.5 - 47.3）cm，P = 0.91]、挽救心肌的比例[26.7%（15.9 - 42.6%）对35.8%（22.4 - 48.8%），P = 0.12]或PIR（8.0%对6.7%，P = 0.62）均无差异。两组之间的复合心血管结局无差异。总之，再灌注前冠状动脉内注射达贝泊汀-α并未减小STEMI患者的梗死面积或减轻梗死后重塑。
