Abstract 3352: Intracoronary Administration Of Bone Marrow-derived Progenitor Cells Abrogates Progressive Left Ventricular Enlargement After AMI: Insights from the REPAIR-AMI Trial
Left ventricular (LV) enlargement is the most important independent determinant of adverse outcome in patients (pts) after AMI. Depressed LV ejection fraction (LVEF) despite successful reperfusion therapy is the single most powerful predictor of progressive LV enlargement after AMI. Therefore, we investigated whether the intracoronary (i.c.) administration of bone marrow-derived progenitor cells (BMC) alters the association between LVEF within 7 days after successful reperfusion therapy for AMI and enddiastolic (EDV) and endsystolic (ESV) volume expansion at 4 months. In the REPAIR-AMI trial paired quantitative LV angiographic data at baseline (4.3 ± 1 days after AMI reperfusion) and at 4 months follow-up were available in 187 pts. 95 pts received i.c. BMC (4.4±1 days post AMI reperfusion therapy), whereas 92 pts received placebo at 4.3 ± 1 days after reperfusion. Baseline LVEF were similar in the BMC (47±10%) and in the placebo group (48±9 %, p = n.s.). At 4 months, ESV increased in the placebo (+6±22ml), but not in the BMC group (−0.6±19ml, p = 0.04 vs. placebo). Baseline LVEF was inversely correlated with ESV expansion at 4 months in the placebo, but not in the BMC group (figure⇓). Likewise, EDV expansion was closely correlated with baseline LVEF in the placebo (r=−0.36, p<0.001), but not in the BMC group (r=−0.17, p=1.0). Finally, ESV expansion determined changes in NT-proBNP serum levels in the placebo (r=−0.38, p=0.006), but not in the BMC group(r=0.05, p=0.68).
Conclusion: I.c. administration of BMC eliminates the correlation between depressed LVEF after reperfusion therapy and LV expansion during follow-up and thereby abrogates progressive LV enlargement after AMI.