Erythropoietin Does Not Reduce Infarct Size in ST-Segment-Elevation Myocardial Infarction

In REVEAL, not only was epoetin alfa of no benefit, a suggestion of harm was seen in patients older than 70.


Pleiotropic effects of erythropoietin include stimulation of angiogenesis and protection against apoptosis. To determine whether erythropoietin has cardioprotective effects during ischemic events, investigators conducted a randomized, double-blind, placebo-controlled, phase 2 trial of a single bolus of intravenous epoetin alfa in patients with ST-segment-elevation myocardial infarction (STEMI) after successful percutaneous coronary intervention. The primary endpoint of the study was infarct size, as assessed by cardiac magnetic resonance (CMR) imaging 2 to 6 days after drug delivery. A second CMR was performed a mean of 12 weeks later.

Over a 3-year period, 222 patients were enrolled at 28 sites. Infarct size did not differ between the epoetin alfa and placebo groups at either the first or the second CMR; nor was any between-group difference seen after adjustment for infarct-affected artery and age (<70 vs. ?70). However, in patients aged ?70, infarct size at first CMR was significantly larger in the epoetin alfa group than in the placebo group. Also, left ventricular volumes were adversely affected by treatment with epoetin alfa in the overall efficacy cohort. The composite safety endpoint of death, MI, stroke, or stent thrombosis occurred in 4% of the epoetin alfa recipients but in none of the placebo recipients.


Citation(s):

Najjar SS et al. for the REVEAL Investigators. Intravenous erythropoietin in patients with ST-segment elevation myocardial infarction: REVEAL — A randomized controlled trial. JAMA 2011 May 11; 305:1863.

Bhatt DL. Evaluation of agents to reduce infarct size: It can be quite REVEALing. JAMA 2011 May 11; 305:1908.