Abstract 10632: Impact of Intracoronary Cell Therapy on Left Ventricular Function in the Setting of Acute Myocardial Infarction, A Collaborative Meta-analysis of Randomized Controlled Clinical Trials
Background The objective of the present collaborative analysis was to systematically examine the effect of intracoronary bone marrow cell (BMC) therapy on left ventricular function after acute myocardial infarction in various subgroups of patients by performing a collaborative patient pooled meta-analysis of all large randomized controlled trials.
Methods We identified all randomized controlled trials comparing intracoronary BMC infusion as treatment for acute myocardial infarction. We contacted the principal investigator for each participating trial to provide summary data with regard to 10 different prespecified subgroups (age, diabetes mellitus, time from symptoms to percutaneous coronary intervention, infarct related artery, left ventricular (LV) end-diastolic volume (EDV), LV ejection fraction (EF), infarct size, presence of microvascular obstruction, timing of cell infusion, and injected cell number) and 3 different endpoints (change in LVEF, LVEDV and LV end-systolic volume (ESV)). Data from all 12 large BMC therapy studies were combined including 1177 patients (631 cell therapy, 446 controls).
Results The absolute improvement in LVEF was greater among BMC treated patients compared to controls: (1.7% increase, 95% Confidence Interval (CI) 0.8 to 2.5, p<0.001). Cell therapy significantly reduced LVEDV and LVESV (-2.8 mL/m², 95% CI -4.8 to -0.9, p<0.001; -3.2 mL/m², 95% CI -4.6 to -1.7, p<0.001, respectively). Treatment benefit in terms of LVEF, LVEDV and LVESV improvement was more pronounced in patients with baseline LVEF <40% and age <55 years (see Figure).
Conclusion For the first time, individual patient data from all large cell therapy studies were pooled and analyzed. We show that intracoronary BMC infusion is associated with improvement of LV function and remodeling in patients after acute myocardial infarction. Especially, younger patients and patients with depressed LVEF at baseline derived most benefit from this adjunctive therapy.
- © 2012 by American Heart Association, Inc.