Abstract
This systematic review with meta-analysis sought to determine protective effects of erythropoietin on clinical outcomes following percutaneous coronary intervention (PCI). Medline, Embase, Elsevier and Sciences online database as well as Google scholar literature were used for selecting appropriate studies with randomized controlled design. The effect sizes measured were odds ratio (OR) for categorical variables and weighted mean difference (WMD) with 95% confidence interval for calculating differences between mean values of duration of hospitalization in intervention and control groups. Values of P < 0.1 for Q test or I 2 > 50% indicated significant heterogeneity between the studies. The literature searches of all major databases retrieved 973 studies. After screening, a total of 15 trials that reported outcomes were identified. Pooled analysis was performed on left ventricular ejection fraction (WMD of − 0.047; 95% CI: − 0.912 to 0.819; P = 0.9), left ventricular end diastolic volume (WMD of − 0.363; 95% CI: − 3.902 to 3.175; P = 0.8), left ventricular end systolic volume (WMD of 0.346; 95% CI: − 2.533 to 3.226; P = 0.8), infarct size (WMD of − 0.446; 95% CI: − 2.352 to − 1.460; P = 0.6), stroke (OR of 2.1; 95% CI: 0.58 to 7.54; P = 0.2), re-myocardial infarction (OR of 1.06; 95% CI: 0.52 to 2.185; P = 0.8), heart failure (OR of 0.53; 95% CI: 0.259 to 1.105; P = 0.09), mortality (OR of 0.56; 95% CI: 0.27 to 1.19; P = 0.13), thrombosis (OR of 0.774; 95% CI: 0.41 to 1.45; P = 0.4), major adverse cardiovascular events (OR of 0.926; 95% CI: 0.63 to 1.35; P = 0.6). Short-term administration of EPO in patients with myocardial infarction (MI) undergoing PCI does not result in improvement in cardiac function, reduction of infarct size and all-cause mortality. Low dose EPO therapy may not be the choice of treatment for the patients with MI, while higher doses might be more effective.
Highlights
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We evaluate effects of erythropoietin on clinical outcomes in patients with myocardial infarction undergoing percutaneous coronary intervention.
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Short-term administration of EPO does not result in improvement in cardiac function, reduction of infarct size and all-cause mortality.
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Low dose EPO therapy may not be the choice of treatment for the patients with MI, while higher doses might be more effective.
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Introduction
Cardiovascular disease is the leading cause of death worldwide . Coronary revascularization is associated with a high success rate of recanalization, contributing to decrease in prevalence of cardiac events and improvement of ventricular contractility and survival prognosis . Rapid reperfusion of ischemic myocardium remains the best treatment for limiting infarct size and further complications . Although additional therapies have been reported for cardioprotection after myocardial infarction (MI), left ventricular remodeling after MI is complicated by cardiac failure accompanying enlargement of left ventricular chamber and worsening long-term prognosis . Erythropoietin (EPO) is commonly known as an effective treatment for anemia, partially caused by an inadequate production of endogenous EPO in patients with chronic renal impairment . EPO is a 165 amino acid glycoprotein with a molecular weight of 34000, and is produced by the kidney in response to hypoxic stimulation. EPO promotes maturation of red blood cells in the bone marrow by binding to receptors coupled to anti-apoptotic Akt and JAK-STAT signaling pathway in erythroid precursors . A functional EPO receptor was found in the cardiovascular system including endothelial cells and cardiomyocytes . Animal model studies have reported that EPO may have cardioprotective effects including attenuating ischemic reperfusion injury, reducing infarct size, and improving LV function . In recent years, several randomized controlled trails have investigated EPO in patients with MI. However, the findings of these trials are controversial. Some studies observed cardioprotective effects with EPO whereas others failed to exhibit any benefit.
This systematic review with meta-analysis sought to determine the strength of evidence for effects of EPO on clinical outcome, echocardiographic and cardiac magnetic resonance imaging results and serum level of creatine kinase in patients with MI undergoing percutaneous coronary intervention (PCI).
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