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.

Abstract

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 (< or =14 days), revascularized percutaneously, with follow-up of > or =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.

• Authors: Michael J Lipinski, Giuseppe G L Biondi-Zoccai, Antonio Abbate, Reena Khianey, Imad Sheiban, Jozef Bartunek, Marc Vanderheyden, Hyo-Soo Kim, Hyun-Jae Kang, Bodo E Strauer, George W Vetrovec
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 50 Issue 18 Pg. 1761-7 (Oct 30 2007) ISSN: 1558-3597 [Electronic] United States
• PMID: 17964040 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)

Topics

• Bone Marrow Transplantation (methods)
• Controlled Clinical Trials as Topic
• Humans
• Myocardial Infarction (physiopathology, therapy)
• Stroke Volume (physiology)
• Ventricular Dysfunction (physiopathology)