Stem‐cell therapy in ST‐segment elevation myocardial infarction with reduced ejection fraction: A multicenter, double‐blind randomized trial

Abstract

BackgroundLeft ventricular ejection fraction (LVEF) is a major determinant of long‐term prognosis after ST‐segment elevation myocardial infarction (STEMI). STEMI patients with reduced LVEF have a poor prognosis, despite successful reperfusion and the use of renin‐angiotensin‐aldosterone inhibitors.HypothesisIntracoronary infusion of bone marrow–derived mononuclear cells (BMMC) may improve LVEF in STEMI patients successfully reperfused.MethodsThe main inclusion criteria for this double‐blind, randomized, multicenter study were patient age 30 to 80 years, LVEF ≤50%, successful angioplasty of infarct‐related artery, and regional dysfunction in the infarct‐related area analyzed before cell injection. Cardiac magnetic resonance imaging was used to assess LVEF, left ventricular volumes, and infarct size at 7 to 9 days and 6 months post–myocardial infarction.ResultsOne hundred and twenty‐one patients were included (66 patients in the BMMC group and 55 patients in the placebo group). The primary endpoint, mean LVEF, was similar between both groups at baseline (44.63% ± 10.74% vs 42.23% ± 10.33%; P = 0.21) and at 6 months (44.74% ± 12.95 % vs 43.50 ± 12.43%; P = 0.59). The groups were also similar regarding the difference between baseline and 6 months (0.11% ± 8.5% vs 1.27% ± 8.93%; P = 0.46). Other parameters of left ventricular remodeling, such as systolic and diastolic volumes, as well as infarct size, were also similar between groups.ConclusionsIn this randomized, multicenter, double‐blind trial, BMMC intracoronary infusion did not improve left ventricular remodeling or decrease infarct size.

Study on correlation between property of coronary artery lesion and degree of coronary artery stenosis of elderly patients with coronary heart disease

“…But, positive remolding leads to Lumen eccentricity and plaque stress increase, and the plaque can easily fracture 19. The changes in some metabolism factors such as postprandial metabolism can also increase blood coagulation, thus leading to the increase of cardiovascular event risk, and unstable clinical manifestations of CHD patients 20,21. Linear correlation analysis showed that coronary artery lesion was positively correlated with LVEF and calcified plaque (P<0.05).…”

Stem cells therapy in acute myocardial infarction: a new era?

“…The ineffectiveness of stem cell transplantation in AMI patients was recently confirmed in CAREMI [ 37 ], MiHeart/AMI [ 38 ], BAMI [ 39 ] and Cardiovascular Cell Therapy Research Network (CCTRN) trials [ 40 ] including a total of 665 patients showing no improvement in LV remodelling and LVEF as well as in reducing the time to all-cause mortality.…”

Cell-Based Therapies for Heart Failure

“…In the following decade, at least ten randomized and multicenter trials using mostly ABMMC, but also selected bone marrow cells, in IHD occurred in the world. All of these trials did not find additional benefits to standard therapy (Traverse et al, 2011;Perin et al, 2012;Traverse et al, 2012;Sürder et al, 2013;Choudry et al, 2016;Sürder et al, 2016;Quyyumi et al, 2017;Wollert et al, 2017;Fernández-Avilés et al, 2018;Nicolau et al, 2018), mostly in acute but one in chronic FIGURE 1 | Cell-based therapies for heart failure. Cell types used in clinical trials include bone marrow mononuclear cells (BMMC), CD34 + mobilized with G-CSF, bone marrow and adipose tissue-derived mesenchymal stromal cells (MSC), embryonic stem cells (ESC), and induced pluripotent stem cells (iPSC).…”