Long-term myocardial functional improvement after autologous bone marrow mononuclear cells transplantation in patients with ST-segment elevation myocardial infarction: 4 years follow-up

Abstract

AimsTo evaluate the safety profile and efficacy of bone marrow mononuclear cells (BMMNC) transplantation for ST-segment elevation myocardial infarction (STEMI) by assessing patients and their left ventricular function at up to 4 years follow-up.Methods and resultsEighty-six patients with STEMI who had successfully undergone percutaneous coronary intervention (PCI) were randomized to receive intracoronary injection of BMMNC (n = 41) or saline (n = 45). Left ventricular ejection fraction, as evaluated by UCG, was markedly improved at 6 months (0.484 ± 0.5 vs. 0.457 ± 0.6, P = 0.001), 1 year (0.482 ± 0.7 vs. 0.446 ± 0.6, P < 0.001), and 4 years (0.505 ± 0.8 vs. 0.464 ± 0.8, P < 0.001) after BMMNC transplant when compared with control group. However, the current cell therapy did not improve the myocardial viability of the infarcted area as assessed by single-photon emission computed tomography analysis at 4 years post-transplant (0.263 ± 0.007 in BMMNC group vs. 0.281 ± 0.008 in control group, P = 0.10). During the follow-up period, one control group case (2.2%) of in-stent restenosis was confirmed by coronary angiography and underwent repeat PCI. Also during follow-up, one death (2.2%) occurred in the control group, and one patient (2.4%) in the BMMNC group had transient acute heart failure.ConclusionThis study indicates that intracoronary delivery of autologous BMMNC is safe and feasible for STEMI patients who have undergone PCI, and can lead to long-term improvement in myocardial function.

Efficacy and Safety of Intracoronary Autologous Bone Marrow‐Derived Cell Transplantation in Patients With Acute Myocardial Infarction: Insights From Randomized Controlled Trials With 12 or More Months Follow‐Up

“…32 Subgroup analysis based on the study by Cao also suggested that younger patients might benefit more from BMC infusion than older patients. 19 In the second instance,more significant LVEF improvementwas observed when BMC were administered 6 or 7 days after acute MI compared to 5 days after acute MI. A more favorable niche of transplanted BMC at 6 or 7 days following acute MI, may contribute to the superior effects of BMC transferred during this time window.…”

“…19 A sensitivity analysis with or without this study showed that BMC transfer was still associated with significant effects on LVEF and LVESV and was associated with a trend toward significant effect on LVEDV and infarct size. This systematic review was based on a comprehensive search strategy.…”

The effect of rigorous study design in the research of autologous bone marrow-derived mononuclear cell transfer in patients with acute myocardial infarction

“…Of these, 622 were nonrandomized studies, editorials, or reviews, and 83 of these were examined in more detail. Seventeen of the 83 references were eligible for inclusion [2][3][4][5][6][7][19][20][21][22][23][24][25][26][27][28][29] (Figure 1). …”

“…Nine of 17 trials implemented identical cardiac catheterization injection procedures after bone marrow aspiration in both the BMSC and control groups to maintain study blindness [2][3][4][5][6][7]19,21]. The surgeon was unaware whether cells or only saline was being injected.…”

Stem Cell Therapy in Myocardial Infarction Clinical Point of View and the Results of the REANIMA Study (REgenerAtion of Myocardium with boNe Marrow Mononuclear Cells in MyocArdial Infarction)

“…Strauer's group, in their non-randomized, but well controlled study had showed that the benefit on intracoronary bone marrow derived MNC infusion after infarction for the myocardial performance sustained after 5 years and that even decreased the abnormal heart rate variability, late potentials and ectopic beats (Yousef (Cao et al, 2009), also indicated the persistent improvement of LVEF (over 4 years) in AMI patients treated with intracoronary bone marrow MNC compared to controls, but interestingly without significant improvement on viability. In BOOST trial (Meyer et al, 2009) patients with more transmural extension of infarction appeared to benefit from BMC transfer throughout the five years.…”