Orlando， FL –来自本年度的ACC会议上，公布了一项关于红细胞生成素（EPO）的前瞻性、安慰剂对照、随机化临床研究，首次评价对于心脏病发作患者短期应用EPO是否能够阻止心肌的进一步损害。

    在心脏病发作的时候，血管成形术和支架植入术能够快速开通梗阻血管，恢复血流，灌溉心肌，从而防止组织的进一步损害。但是即使成功恢复血流再灌注，也有一部分患者心脏出现不可逆转的损伤，最终发展为心力衰竭。

    保护受损心肌我们还能做些什么？基于以上考虑，促红细胞生成素治疗ST抬高心肌梗死再生心肌研究(REVIVAL-3)应运而生。本研究旨在探讨在急性缺血缺氧（心肌梗死）状态下，PCI后立即高剂量短期注射EPO能否防止心肌细胞程序性死亡或凋亡。

     “如果EPO能够减少细胞凋亡和组织坏死，甚至是改善新生血管生成，这将对心肌缺血和再灌注产生保护作用，” 来自德国的Ilka Ott博士说，“这将减少心脏事件后心肌损害，并可改善左室功能。”

    EPO是调节红细胞生成的激素。动物研究表明，EPO可通过减少程序性细胞死亡和增加新生血管形成减少心肌梗死的面积和改善心功能。但是对于其在心梗患者中的作用证据尚少。

    在REVIVAL-3研究中，纳入138例ST抬高心肌梗死患者。研究对象被随机分为安慰机组和EPO组，在PCI术后即刻、24小时以及48小时分别给予静脉药物注射。

    研究者将报告注射药物4-6周后应用MRI测量左室射血分数的情况，该研究也将收集心肌梗死后心肌损害的数量、左室容积、重要临床不良事件包括死亡、再发心肌梗死、卒中、再次血运重建、出血和其他血液系统并发症的相关数据。让我们拭目以待临床结果的揭晓！

（张丽洁 吕树铮  首都医科大学附属北京安贞医院）

英文原文：
CAN ERYTHROPOIETIN LIMIT HEART ATTACK DAMAGE?
Study tests erythropoietin’s ability to halt programmed cell death
*** FINAL DATA NOT YET IN***FINAL DATA TO BE PRESENTED***

Orlando， FL – The first prospective， placebo-controlled， randomized trial to evaluate the effects of short-term erythropoietin administration on patients who are having a heart attack could show whether erythropoietin can protect against further heart damage， according to research presented today at the American College of Cardiology’s 58th annual scientific session. ACC.09 is the premier cardiovascular medical meeting， connecting cardiologists and cardiovascular specialists to the latest and most innovative findings in cardiovascular science

During a heart attack， angioplasty and stenting are used to rapidly open the blocked coronary artery and restore blood flow to the heart muscle， in hopes of preventing tissue death. Despite successful blood flow， or reperfusion， a substantial number of patients experience irreversible damage to the heart and eventually develop heart failure.
What more can be done to protect the heart muscle is the question being addressed by the Regeneration of Vital Myocardium in ST-Segment Elevation Myocardial Infarction by Erythropoietin (REVIVAL-3) study. The study offers insight into whether a short-term infusion of high-dose erythropoietin immediately after percutaneous coronary intervention (PCI) can protect the heart muscle against programmed cell death， or apoptosis， after a critical shortage of blood and oxygen (ischemia). 

 “If erythropoietin can limit cell apoptosis and tissue death， and even enhance the growth of new blood vessels， it could be protective after a combination of myocardial ischemia and reperfusion，” said Ilka Ott， M.D.， a professor of cardiology at Deutsches Herzzentrum. Medizinische Klinik der Technischen， Universität München， Munich， Germany. “This could lead to a reduction in the amount of heart muscle damaged by the heart attack and improvement in left ventricular function.”
Erythropoietin is a hormone that regulates the production of red blood cells. It has been shown to reduce heart attack size and improve heart function in animal studies by limiting programmed cell death and enhancing the growth of new blood vessels. However， little evidence exists on its effects in patients who have had a heart attack.
For the study， researchers recruited 138 patients experiencing their first ST-elevation myocardial infarction (STEMI). Patients were randomly assigned to receive a placebo or an intravenous infusion of erythropoietin immediately， 24， and 48 hours after PCI.

Researchers will report on the effects of erythropoietin on left ventricular ejection fraction – the percentage of blood the left ventricle squeezes into the blood vessels with each beat – at four to six months after entry into the study， as measured by magnetic resonance imaging (MRI). The study is also collecting data on the amount of heart muscle damaged by the heart attack， left ventricular volumes and important clinical events including death， repeat heart attack， stroke， repeat heart procedures， and bleeding and other blood system complications.