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Heart. 2013 Feb;99(4):225-32. doi: 10.1136/heartjnl-2012-302230. Epub 2012 Aug 8.

Impact of intracoronary cell therapy on left ventricular function in the setting of acute myocardial infarction: a meta-analysis of randomised controlled clinical trials.

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1
Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.

Abstract

CONTEXT:

Numerous randomized controlled studies assessing intracoronary bone marrow cell therapy (BMC) after acute myocardial infarction (AMI) have been performed.

OBJECTIVE:

To systematically review the effect of autologous BMC therapy on left ventricular function by performing an up to date meta-analysis of randomized controlled trials (RCTs) including long-term follow-up.

DATA SOURCES:

Trials were indentified through a literature search from 1980 to June 2012 of the Pubmed, Embase, Cochrane database, and the Current Controlled Trials Register.

STUDY SELECTION:

Randomized clinical trials comparing intracoronary BMC infusion to control as treatment for AMI.

DATA EXTRACTION:

The primary endpoint was the change in left ventricular ejection fraction (LVEF) from baseline to follow-up. Secondary endpoints were changes in left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), infarct size and clinical outcomes.

RESULTS:

Improvement of LVEF in patients receiving intracoronary BMC was significantly better within 6 months (23 studies, 2.23% (95% confidence interval (CI) 1.00 to 3.47); p<0.001). At 12 months of follow-up, this effect sustained with 3.91% more LVEF improvement (11 studies, (95% CI 2.56 to 5.27), p<0.001). At long-term follow-up, we found a trend for better LVEF improvement in favor of cell therapy (7 studies, 1.90% (95% CI -0.43 to 4.23); p=0.11). There was no clear effect in infarct size or LVEDV. However, we found a significant reduction in LVESV at 6 months (-4.81 ml (95% CI -7.86 to -1.76); p<0.001 and at 12 months (-9.41 ml (95% CI -13.64 to -5.17); p<0.001). Moreover, there was a statistically significant decrease in recurrent AMI (Relative Risk (RR) 0.44 (95% CI 0.24 to 0.79); p=0.007), and readmission for heart failure, unstable angina or chest pain (RR 0.59 (95% CI 0.35 to 0.98); p=0.04) in favour of cell therapy.

CONCLUSION:

Intracoronary BMC treatment leads to a moderate improvement of LVEF and reduction of LVESV at 6 months that sustained at 12 months follow-up, without a clear significant effect on LVEDV, or infarct size. Furthermore, we found that intracoronary cell therapy is significantly associated with a reduction in recurrent AMI and readmission for heart failure, unstable angina or chest pain.

PMID:
22875736
DOI:
10.1136/heartjnl-2012-302230
[Indexed for MEDLINE]
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