Results from the HEBE III study, a prospective, randomised, multicentre trial performed in seven centres in the Netherlands, suggest that the promising effects of erythropoieitin seen in previous smaller studies cannot be confirmed for the improvement of clinical outcome in patients with a first ST-elevation myocardial infarction.

Myocardial infarction remains a major hazard for millions of patients in Europe. Despite improvements in treatment, the majority still end up with reduced cardiac function, and strategies to improve post-myocardial infarction cardiac function are strongly needed. One approach, suggested in experimental and smaller clinical studies, is the administration of Erythropoietin, currently used for the treatment of anemia caused by renal disease.
The HEBE III study was designed to study the effects of a single intravenous bolus of Epoetin alpha on clinical outcome in patients with a first ST-elevation myocardial infarction. The primary endpoint of the trial was left ventricular ejection fraction ( LVEF ) after six weeks, with secondary endpoints assessed according to infarct size and major adverse cardiovascular events ( MACE ).

The trial was conducted in 529 randomised STEMI patients and headline results showed that this single IV bolus of Epoetin alfa ( Epogen, Procrit; in Italy: Eprex ) did not improve cardiac function. However, patients who received Epoetin alfa had fewer major cardiac events, such as heart failure, compared with the control group.

The HEBE III trial studied the effect of a single bolus of 60,000 IU Epoetin alfa on LVEF. Epoetin alfa was administered intravenously within three hours after a successful PCI ( percutaneous coronary intervention ) for a first STEMI.
The study aimed to find a 3% increase of LVEF in patients treated with Epoetin alfa compared to standard care. In total, 529 patients were included in the study, in which 263 patients were assigned to the Epoetin alfa group and 266 to the control group.

After six weeks, LVEF was 53% in the Epoetin alfa group and 52% in the control group, but this 1% difference was too small to be statistically or clinically significant. Furthermore, infarct size, measured by proteins in the blood, was also not significantly different between the two groups. However, in the Epoetin alfa group, only eight patients suffered a major cardiac adverse event, compared to 19 in the control group.

Source: European Society of Cardiology ( ESC ) Meeting, 2010

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