CLINICAL RESEARCH: MYOCARDIAL INFARCTION
Impact of Intracoronary Cell Therapy on Left Ventricular Function in the Setting of Acute Myocardial InfarctionA Collaborative Systematic Review and Meta-Analysis of Controlled Clinical Trials
Michael J. Lipinski, MD*, ,2,
Giuseppe G.L. Biondi-Zoccai, MD ,2,*,
Antonio Abbate, MD,
Reena Khianey, MD,
Imad Sheiban, MD,
Jozef Bartunek, MD, PhD ,1,
Marc Vanderheyden, MD,1,
Hyo-Soo Kim, MD||,
Hyun-Jae Kang, MD||,
Bodo E. Strauer, MD# and
George W. Vetrovec, MD
* Department of Internal Medicine, University of Virginia, Charlottesville, Virginia
Virginia Commonwealth University, Pauley Heart Center, Richmond, Virginia
Interventional Cardiology, Division of Cardiology, University of Turin, Turin, Italy
Cardiovascular Center and Cardiovascular Research Center, Aalst, Belgium
|| Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
# Department of Internal Medicine, Division of Cardiology, Pneumology, and Angiology, Heinrich Heine University, Duesseldorf, Germany.
Manuscript received May 21, 2007;
revised manuscript received July 16, 2007,
accepted July 17, 2007.
* Reprint requests and correspondence: Dr. Giuseppe Biondi-Zoccai, Interventional Cardiology, Division of Cardiology, University of Turin, S. Giovanni Battista "Molinette" Hospital, Corso Bramante 88-90, 10126 Turin, Italy. (Email: gbiondizoccai{at}gmail.com).
Objectives: We aimed to perform a meta-analysis of clinical trials on intracoronary cell therapy after acute myocardial infarction (AMI).
Background: Intracoronary cell therapy continues to be evaluated in the setting of AMI with variable impact on left ventricular ejection fraction (LVEF).
Methods: We searched the CENTRAL, mRCT, and PubMed databases for controlled trials reporting on intracoronary cell therapy performed in patients with a recent AMI ( 14 days), revascularized percutaneously, with follow-up of  3 months. The primary end point was change in LVEF, and secondary end points were changes in infarct size, cardiac dimensions, and dichotomous clinical outcomes.
Results: Ten studies were retrieved (698 patients, median follow-up 6 months), and pooling was performed with random effect. Subjects that received intracoronary cell therapy had a significant improvement in LVEF (3.0% increase [95% confidence interval (CI) 1.9 to 4.1]; p < 0.001), as well as a reduction in infarct size (–5.6% [95% CI –8.7 to –2.5]; p < 0.001) and end-systolic volume (–7.4 ml [95% CI –12.2 to –2.7]; p = 0.002), and a trend toward reduced end-diastolic volume (–4.6 ml [95% CI –10.4 to 1.1]; p = 0.11). Intracoronary cell therapy was also associated with a nominally significant reduction in recurrent AMI (p = 0.04) and with trends toward reduced death, rehospitalization for heart failure, and repeat revascularization. Meta-regression suggested the existence of a dose-response association between injected cell volume and LVEF change (p = 0.066).
Conclusions: Intracoronary cell therapy following percutaneous coronary intervention for AMI appears to provide statistically and clinically relevant benefits on cardiac function and remodeling. These data confirm the beneficial impact of this novel therapy and support further multicenter randomized trials targeted to address the impact of intracoronary cell therapy on overall and event-free long-term survival.
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Abbreviations and Acronyms
| | AMI = acute myocardial infarction | | BMC = bone marrow cell | | CI = confidence interval | | G-CSF = granulocyte colony-stimulating factor | | LV = left ventricular | | LVEDV = left ventricular end-diastolic volume | | LVEF = left ventricular ejection fraction | | LVESV = left ventricular end-systolic volume | | OR = odds ratio | | PMC = peripheral mononuclear cell | | TVR = target vessel revascularization |
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