No Benefit to Epoetin Alfa Bolus After PCI for STEMI

Epoetin alfa bolus does not reduce infarct size and is tied to increased cardiovascular events

TUESDAY, May 10 (HealthDay News) -- Patients with ST-segment elevation myocardial infarction (STEMI) who undergo successful reperfusion may not benefit from a single intravenous bolus of epoetin alfa within four hours of percutaneous coronary intervention (PCI), according to a study published in the May 11 issue of the Journal of the American Medical Association.

Samer S. Najjar, M.D., from the National Institutes of Health in Baltimore, and colleagues evaluated safety and efficacy of a single intravenous bolus of 60,000 U epoetin alfa in patients with STEMI. Dose-escalation was used to assess safety, and a single dose measured efficacy of epoetin alfa. A total of 222 participants underwent successful PCI as a primary or rescue reperfusion strategy, and within four hours were assigned to treatment with epoetin alfa or placebo. Infarct size was assessed by cardiac magnetic resonance (CMR) imaging carried out two to six days after medication administration, and an average of 12 weeks later.

The investigators found that, in the efficacy cohort there was no difference between the infarct size in the epoetin or placebo groups on the first or second CMR scan. For patients aged 70 years or older, the average infarct size at the first CMR scan was significantly larger in the epoetin alfa group, compared with the placebo group. In the safety cohort, the composite outcome of death, MI, stroke, or stent thrombosis occurred in five patients (4 percent), compared with none in the placebo group.

"A single bolus of 60,000 U of epoetin alfa in patients with STEMI within four hours following successful PCI did not reduce infarct size and was associated with higher rates of adverse cardiovascular events," the authors write.

Several of the study authors disclosed financial ties to the pharmaceutical, medical device, and biotechnological industries, and with law firms for whom they provide expert testimony. One of the study authors is an inventor on a U.S. patent for Delayed Enhancement MRI.

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