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Circ Res. 2017 Jan 20;120(2):324-331. doi: 10.1161/CIRCRESAHA.115.308165. Epub 2016 Nov 7.

PreSERVE-AMI: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial of Intracoronary Administration of Autologous CD34+ Cells in Patients With Left Ventricular Dysfunction Post STEMI.

Author information

1
From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.). aquyyumi@emory.edu.
2
From the Emory Clinical Cardiovascular Research Institute, Cardiology Division, Emory University School of Medicine, Atlanta, GA (A.A.Q., J.P.); Athens Regional Cardiology, GA (J.P.); Division of Cardiology, Huntsville Hospital, Huntsville, AL (A.V.); The Christ Hospital Heart and Vascular Center, Cincinnati, OH (D.J.K.); Rutgers University, New Jersey Medical School, Newark (M.K.); Division of Cardiology, Rush University Medical Center, Chicago, IL (G.L.S.); Department of Medicine, Division of Cardiology, University of Kentucky, Lexington (A.A.-L.); Emory St. Joseph's Hospital, Atlanta, GA (S.F.); Division of Cardiology, Cedars-Sinai Heart Institute, Los Angeles, CA (T.D.H.); Scripps Health, La Jolla, CA (R.A.S.); Heart Sciences Center, Gilbert, AZ (N.D.); University of Pittsburgh Medical Center, PA (C.T.); Bluhm Cardiovascular Institute Northwestern Memorial Hospital, Chicago, IL (C.J.D.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (G.W.B.); Cardiovascular Medicine, University of Southern California, Los Angeles, CA (D.M.S.); Westchester Heart and Vascular, Westchester Medical Center, Valhalla, NY (M.C.); Caladrius Biosciences Inc, Basking Ridge, NJ (T.M., P.H., A.M.K., V.D., A.C., C.J., R.A.P., R.L.S., D.J.M., A.P., D.W.L.); and PCT, LLC, A Caladrius Company, Allendale, NJ (R.A.P.).

Abstract

RATIONALE:

Despite direct immediate intervention and therapy, ST-segment-elevation myocardial infarction (STEMI) victims remain at risk for infarct expansion, heart failure, reinfarction, repeat revascularization, and death.

OBJECTIVE:

To evaluate the safety and bioactivity of autologous CD34+ cell (CLBS10) intracoronary infusion in patients with left ventricular dysfunction post STEMI.

METHODS AND RESULTS:

Patients who underwent successful stenting for STEMI and had left ventricular dysfunction (ejection fraction≤48%) ≥4 days poststent were eligible for enrollment. Subjects (N=161) underwent mini bone marrow harvest and were randomized 1:1 to receive (1) autologous CD34+ cells (minimum 10 mol/L±20% cells; N=78) or (2) diluent alone (N=83), via intracoronary infusion. The primary safety end point was adverse events, serious adverse events, and major adverse cardiac event. The primary efficacy end point was change in resting myocardial perfusion over 6 months. No differences in myocardial perfusion or adverse events were observed between the control and treatment groups, although increased perfusion was observed within each group from baseline to 6 months (P<0.001). In secondary analyses, when adjusted for time of ischemia, a consistently favorable cell dose-dependent effect was observed in the change in left ventricular ejection fraction and infarct size, and the duration of time subjects was alive and out of hospital (P=0.05). At 1 year, 3.6% (N=3) and 0% deaths were observed in the control and treatment group, respectively.

CONCLUSIONS:

This PreSERVE-AMI (Phase 2, randomized, double-blind, placebo-controlled trial) represents the largest study of cell-based therapy for STEMI completed in the United States and provides evidence supporting safety and potential efficacy in patients with left ventricular dysfunction post STEMI who are at risk for death and major morbidity.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Unique identifier: NCT01495364.

KEYWORDS:

cell transplantation; clinical trial; endothelial progenitor cells; heart failure; myocardial infarction

PMID:
27821724
PMCID:
PMC5903285
DOI:
10.1161/CIRCRESAHA.115.308165
[Indexed for MEDLINE]
Free PMC Article

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