Efficacy of IntraCoronary Erythropoietin Delivery BEfore Reperfusion-Gauging Infarct Size in Patients with Acute ST-segment Elevation Myocardial Infarction (ICEBERG)

• Published in: International Heart Journal Vol. 60; no. 2; pp. 255 - 263
• Main Authors: Seo, Won-Woo, Suh, Jung-Won, Oh, Il-Young, Yoon, Chang-Hwan, Cho, Young-Seok, Youn, Tae-Jin, Chae, In-Ho, Choi, Dong-Ju
• Format: Journal Article
• Language: English
• Published: Japan International Heart Journal Association 30-03-2019; Japan Science and Technology Agency
• Subjects: Aged; Angioplasty, Balloon, Coronary - methods; Balloon treatment; Calcium-binding protein; Coronary Vessels; Darbepoetin alfa; Darbepoetin alfa - administration & dosage; Darbepoetin alfa - adverse effects; Drug Monitoring - methods; Electrocardiography; Erythropoietin; Female; Heart; Heart attacks; Hematinics - administration & dosage; Hematinics - adverse effects; Humans; Infusions, Intra-Arterial; Ischemia; Left ventricle remodeling; Magnetic Resonance Imaging, Cine - methods; Male; Middle Aged; Myocardial infarction; Myocardium; Myocardium - pathology; Preoperative Care - methods; Reperfusion; ST Elevation Myocardial Infarction - diagnosis; ST Elevation Myocardial Infarction - therapy; Stroke Volume - drug effects; Treatment Outcome; Troponin; Ventricle; Ventricular Remodeling - drug effects; Left ventricle remodeling; Darbepoetin alfa
• ISSN: 1349-2365; 1349-3299
• DOI: 10.1536/ihj.18-035

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) cm3, 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.