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J Am Coll Cardiol, 2007; 50:1761-1767, doi:10.1016/j.jacc.2007.07.041 (Published online 12 October 2007).
© 2007 by the American College of Cardiology Foundation
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CLINICAL RESEARCH

Impact of Intracoronary Cell Therapy on Left Ventricular Function in the Setting of Acute Myocardial Infarction

A Collaborative Systematic Review and Meta-Analysis of Controlled Clinical Trials

Michael J. Lipinski, MD*,{dagger}, Giuseppe G.L. Biondi-Zoccai, MD{ddagger},*, Antonio Abbate, MD{dagger}, Reena Khianey, MD{dagger}, Imad Sheiban, MD{ddagger}, Jozef Bartunek, MD, PhD§, Marc Vanderheyden, MD§, Hyo-Soo Kim, MD||, Hyun-Jae Kang, MD||, Bodo E. Strauer, MD# and George W. Vetrovec, MD{dagger}

* Department of Internal Medicine, University of Virginia, Charlottesville, Virginia
{dagger} Virginia Commonwealth University, Pauley Heart Center, Richmond, Virginia
{ddagger} 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.

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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