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CLINICAL RESEARCH: MYOCARDIAL INFARCTION

High Serum Erythropoietin Level Is Associated With Smaller Infarct Size in Patients With Acute Myocardial Infarction Who Undergo Successful Primary Percutaneous Coronary Intervention

Shigeto Namiuchi, MD^_*, Yutaka Kagaya, MD^,_*, Jun Ohta, MD, Nobuyuki Shiba, MD, Masafumi Sugi, MD^_*, Masayoshi Oikawa, MD^_*, Hiroyuki Kunii, MD^_*, Hidetsugu Yamao, MD^_*, Nobuo Komatsu, MD^_*, Mitsuru Yui, MD^_*, Hiroko Tada, MD, Masahito Sakuma, MD, Jun Watanabe, MD, Toshikatsu Ichihara, MD^_* and Kunio Shirato, MD

^_* Department of Cardiology, Iwaki Kyoritsu General Hospital, Iwaki, Japan
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan

Manuscript received December 13, 2004; accepted January 5, 2005.

^_* Reprint requests and correspondence: Dr. Yutaka Kagaya, Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai 980-8574, Japan (Email: kagaya{at}cardio.med.tohoku.ac.jp).

OBJECTIVES: We investigated whether a higher serum erythropoietin (EPO) level in patients with acute myocardial infarction (MI) subjected to successful primary percutaneous coronary intervention (PCI) can predict a smaller infarct size determined by creatine kinase (CK) release.

BACKGROUND: Erythropoietin has been shown to protect cardiomyocytes from ischemia-reperfusion injury in rodents.

METHODS: We prospectively studied 101 patients with first MI who received successful primary PCI within 12 h from the onset of MI. Blood samples were collected to examine the serum EPO level after the primary PCI and within 24 h from the onset of MI.

RESULTS: The peak CK level and cumulative CK release were significantly lower in the above-median EPO group than in the below-median EPO group. Thrombolysis In Myocardial Infarction (TIMI) grades and collateral grades before PCI, infarct-related coronary arteries, time to the successful reperfusion from the onset of MI, and serum creatinine levels were similar in the two EPO groups. A stepwise multiple regression analysis revealed that the absolute serum EPO level (mU/ml) as well as TIMI grades after PCI and preinfarction angina was an independent predictor for the cumulative CK release.

CONCLUSIONS: These data suggest that a high endogenous EPO level can predict a smaller infarct size in patients with acute MI subjected to successful primary PCI. This might be attributed to the potentially protective effect of endogenous EPO against ischemia-reperfusion injury in humans.

Abbreviations and Acronyms   BNP = brain natriuretic peptide   CK = creatine kinase   EPO = erythropoietin   LV = left ventricle/ventricular   MI = myocardial infarction   PCI = percutaneous coronary intervention   TIMI = Thrombolysis In Myocardial Infarction

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