Abstract 3378: Amelioration of Early Ventricular Remodeling by Intracoronary Progenitor Cell Infusion in Patients with AMI is Associated with Improved Late Clinical Outcome
Background: Intracoronary administration of bone marrow-derived progenitor cells (BMC) beneficially affected left ventricular remodeling within 4 months in the REPAIR-AMI trial. Preliminary 2 year follow-up suggests that also cardiovascular event rate is beneficially affected. However, the relation between BMC-associated amelioration of early remodeling and long-term events is unclear.
Methods: In the double-blind REPAIR-AMI trial patients with reperfused AMI were randomized to intracoronary infusion of BMC (n=101) or placebo medium (n=103) into the infarct artery. Ejection Fraction (EF) and endsystolic volumes (ESV) were measured with quantitative left ventricular angiography at baseline and 4 months. Late cardiac events - between 4 months and 2 years - were assessed as death, myocardial infarction, revascularization procedures or rehospitalization for heart failure.
Results: Baseline EF and ESV were comparable between the groups. BMC therapy was associated with a beneficial effect on early ventricular remodeling, defined as the combined change in EF and ESV (BMC: EF + 5.5±7.3; ESV − 0.6±19ml versus Placebo: EF +3.0±6.5; ESV +5.6±23ml; p = 0.042). Likewise, BMC infusion was associated with lower risk of late events (15% vs. 27%, p = 0.031). Of note, early remodeling was associated with late cardiac event in the placebo group (p = 0.027), but not in the BMC group (figure⇓). Thus, ameliorating early remodeling with BMC infusion may contribute to reduction of late cardiac events.
Conclusions: Intracoronary infusion of BMC beneficially affects early ventricular remodeling processes, which may importantly contribute to the observed reduction of late cardiac events.