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

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Abstract

Purpose

Current evidence suggests that erythropoiesis-stimulating agents (ESAs), including erythropoietin and darbepoetin, may have a direct cardio-protective effect. However, randomized controlled trials (RCTs) assessing the efficacy and safety of ESAs in patients with acute ST-segment elevation myocardial infarction (STEMI) have yielded heterogeneous results. Here, we performed a meta-analysis of RCTs to assess whether the administration of ESAs can improve cardiac functional parameters, such as left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), and left ventricular end-diastolic volume (LVEDV), and attenuate infarct size in patients with acute STEMI.

Methods and results

The PubMed, EBSCO, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched for relevant RCT studies on ESAs published before May 13, 2011. A total of nine RCTs involving 1,244 participants were identified. The original data of these studies were aggregated using fixed effect models. Compared with controls, the administration of ESAs showed a slight but significant improvement in LVEF (1.38%; 95% confidence interval 0.38–2.37%; p = 0.007). However, no significant improvement in LVEDV, LVESV, and infarct size was observed, and no increase in all-cause severe adverse effect was indicated.

Conclusions

Our meta-analysis indicates that the superiority of ESAs over conventional therapy in patients with acute STEMI is limited using current procedures. However, there is evidence to suggest that the timing and dosing of ESA administration may be optimized. Moreover, the long-term cardio-protective effect of ESAs in this patient population may be beneficial and worth exploring.

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Abbreviations

AMI:

Acute myocardial infarction

EPO:

Erythropoietin

EPOR:

Erythropoietin receptors

ESAs:

Erythropoiesis-stimulating agents

LVEF:

Left ventricular ejection fraction

LVEDV:

Left ventricular end diastolic volume

LVESV:

Left ventricular end-systolic volume

PCI:

Percutaneous coronary intervention

STEMI:

ST-segment elevation myocardial infarction

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Acknowledgments

This work was supported by the National Natural Science Foundation of China (Grant no. 81100386) and the Fundamental Research Funds for the Central Universities (Grant no. 1107021461), P.R. China. There was no pharmaceutical industry support for this study.

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Authors and Affiliations

  1. Department of Hematology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China

    Juan Li

  2. Department of Ophthalmology, Wuxi No. 2 People’s Hospital, Wuxi, China

    Huiyan Xu

  3. Center of Translational Medicine, Nanjing University Medical School, 22 Hankou Road, Nanjing, 210093, China

    Qian Gao & Yanting Wen

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  1. Juan Li
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  2. Huiyan Xu
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  3. Qian Gao
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  4. Yanting Wen
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Corresponding author

Correspondence to Yanting Wen.

Additional information

Juan Li and Huiyan Xu contributed equally to this paper.

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Li, J., Xu, H., Gao, Q. et al. Effect of erythropoiesis-stimulating agents in acute ST-segment elevation myocardial infarction: a systematic review. Eur J Clin Pharmacol 68, 469–477 (2012). https://doi.org/10.1007/s00228-011-1160-y

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  • DOI: https://doi.org/10.1007/s00228-011-1160-y

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