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Safety and clinical outcome of erythropoiesis-stimulating agents in patients with ST-elevation myocardial infarction: a meta-analysis of individual patient data.

Publication ,  Journal Article
Fokkema, ML; van der Meer, P; Rao, SV; Belonje, AM; Ferrario, M; Hillege, HL; Katz, SD; Lipšic, E; Ludman, AJ; Ott, I; Prunier, F; Choi, D-J ...
Published in: Am Heart J
September 2014

BACKGROUND: Erythropoiesis-stimulating agents (ESAs) have been investigated in small studies in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Erythropoiesis-stimulating agents did not show a clear effect on left ventricular function or clinical outcome, but some studies suggested an increased risk of thromboembolic events. METHODS: A systematic literature search in MEDLINE was performed, until December 2012. We included randomized clinical trials investigating the effect of ESAs in STEMI patients undergoing primary PCI, with ≥30 days of follow-up. The primary end point was a composite of all-cause mortality, myocardial infarction, and stent thrombosis after PCI. Secondary end point was all-cause mortality. RESULTS: Individual patient data were obtained from 10 of 11 trials, including 97.3% (1,242/1,277) of all patients randomized to control (n = 600) or to ESAs (n = 642). Baseline characteristics were well balanced between the treatment allocations. Mean follow-up time was 248 (±131) days. The primary end point occurred in 3.5% (20/577) in the control group and in 2.1% (13/610) in the ESA group (hazard ratio for ESAs, 0.63; 95% CI [0.31-1.27]; P = .20). Mortality occurred in 13 (2.3%) in the control group and 5 (0.8%) in the ESA group (hazard ratio for ESAs, 0.38; 95% CI [0.13-1.06]; P = .06). CONCLUSIONS: Erythropoiesis-stimulating agent administration does not result in an increased risk of adverse cardiac events in STEMI patients undergoing primary PCI. Results of ongoing studies may provide further insight to the potential beneficial clinical effects of ESAs in STEMI patients.

Duke Scholars

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

September 2014

Volume

168

Issue

3

Start / End Page

354 / 362.e2

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Thromboembolism
  • Risk Assessment
  • Percutaneous Coronary Intervention
  • Myocardial Infarction
  • Humans
  • Hematinics
  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services
 

Citation

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Fokkema, M. L., van der Meer, P., Rao, S. V., Belonje, A. M., Ferrario, M., Hillege, H. L., … Voors, A. A. (2014). Safety and clinical outcome of erythropoiesis-stimulating agents in patients with ST-elevation myocardial infarction: a meta-analysis of individual patient data. Am Heart J, 168(3), 354-362.e2. https://doi.org/10.1016/j.ahj.2014.04.020
Fokkema, Marieke L., Peter van der Meer, Sunil V. Rao, Anne M. Belonje, Maurizio Ferrario, Hans L. Hillege, Stuart D. Katz, et al. “Safety and clinical outcome of erythropoiesis-stimulating agents in patients with ST-elevation myocardial infarction: a meta-analysis of individual patient data.Am Heart J 168, no. 3 (September 2014): 354-362.e2. https://doi.org/10.1016/j.ahj.2014.04.020.
Fokkema ML, van der Meer P, Rao SV, Belonje AM, Ferrario M, Hillege HL, et al. Safety and clinical outcome of erythropoiesis-stimulating agents in patients with ST-elevation myocardial infarction: a meta-analysis of individual patient data. Am Heart J. 2014 Sep;168(3):354-362.e2.
Fokkema, Marieke L., et al. “Safety and clinical outcome of erythropoiesis-stimulating agents in patients with ST-elevation myocardial infarction: a meta-analysis of individual patient data.Am Heart J, vol. 168, no. 3, Sept. 2014, pp. 354-362.e2. Pubmed, doi:10.1016/j.ahj.2014.04.020.
Fokkema ML, van der Meer P, Rao SV, Belonje AM, Ferrario M, Hillege HL, Katz SD, Lipšic E, Ludman AJ, Ott I, Prunier F, Choi D-J, Toba K, van Veldhuisen DJ, Voors AA. Safety and clinical outcome of erythropoiesis-stimulating agents in patients with ST-elevation myocardial infarction: a meta-analysis of individual patient data. Am Heart J. 2014 Sep;168(3):354-362.e2.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

September 2014

Volume

168

Issue

3

Start / End Page

354 / 362.e2

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Thromboembolism
  • Risk Assessment
  • Percutaneous Coronary Intervention
  • Myocardial Infarction
  • Humans
  • Hematinics
  • Cardiovascular System & Hematology
  • 3201 Cardiovascular medicine and haematology
  • 1117 Public Health and Health Services