Abstract 13064: Cell Functionality of Administered Autologous Bone Marrow-Derived Mononuclear Cells Predicts 5-Year Clinical Outcome in Patients with Acute Myocardial Infarction - Results of The REPAIR-AMI Trial
Background: In the REPAIR-AMI trial, intracoronary administration of autologous bone marrow-derived mononuclear cells (BM-MNC) was associated with a significantly greater recovery of contractile function compared to Placebo in patients (pts) following acute myocardial infarction at 4 months follow-up. The current analysis investigates predictors of 5-year survival free of cardiac death and rehospitalisation for CHF in pts treated with either BM-MNC or Placebo.
Methods: In the multicenter, Placebo-controlled double-blind REPAIR-AMI trial, 204 pts received either intracoronary infusion of BM-MNC (n=101) or Placebo (n=103) into the infarct vessel 3 to 7 days following successful reperfusion of AMI.
Results: Clinical follow-up was completed for 98% of pts (97% in the Placebo, 99% in the BMC group) during extended 5-year follow-up. A total of 15 pts died in the Placebo group compared to 7 pts in the BM-MNC group (p=0.07). 9 Pts in the Placebo and 5 pts in the BMC group required rehospitalization for CHF (p=0.3). The combined endpoint cardiac / cardiovascular death or rehospitalisation for heart failure was more frequent in the Placebo (18 events) compared to the BM-MNC group (10 events; p=0.15). For the entire study cohort, univariate predictors of adverse outcome were age (p=0.01), the CADILLAC score (p<0.001), aldosterone antagonist treatment (p<0.001), changes in LVEF (p<0.01), LVESV (p<0.001), and NT-proBNP (p=0.002) at 4 months. In the Placebo group, the identical predictors of adverse outcome were identified. In contrast, in the BMC group, none of these predictors remained to be significantly associated with adverse outcome. However, the basal (p=0.02) as well as the SDF-1-induced (p=0.05) migratory capacity of the administered BMC was associated with improved clinical outcome.
Conclusion: In pts of the REPAIR-AMI trial assessing the effects of intracoronary BMC administration post-AMI, established clinical parameters are associated with adverse outcome at 5 years exclusively in the Placebo group, whereas function of the administered BMC determines eventfree survival in the BM-MNC treated pts. These data, for the first time, disclose a cause-and-effect relationship between cell therapy and long-term clinical outcome in pts with AMI.
- © 2012 by American Heart Association, Inc.