Key result
Intracoronary autologous progenitor cell infusion increases LVEF by ~9% at 4 months post-AMI.
Why the study?
The safety and feasibility of autologous progenitor cell transplantation in patients with ischemic heart disease after acute myocardial infarction is unknown.
Does intracoronary infusion of autologous progenitor cells improve left ventricular ejection fraction and remodeling in patients with reperfused acute myocardial infarction?
RCT (n=20)
Randomly allocated
Does intracoronary infusion of autologous progenitor cells improve left ventricular ejection fraction and remodeling in patients with reperfused acute myocardial infarction?
Absolute Event Rate: 60.1% vs 53.5%
p-value: p=0.003
Intracoronary infusion of autologous progenitor cells after acute myocardial infarction is feasible, safe, and associated with improved left ventricular ejection fraction and remodeling at 4 months.
BACKGROUND: Experimental studies suggest that transplantation of blood-derived or bone marrow-derived progenitor cells beneficially affects postinfarction remodeling. The safety and feasibility of autologous progenitor cell transplantation in patients with ischemic heart disease is unknown. METHODS AND RESULTS: We randomly allocated 20 patients with reperfused acute myocardial infarction (AMI) to receive intracoronary infusion of either bone marrow-derived (n=9) or circulating blood-derived progenitor cells (n=11) into the infarct artery 4.3+/-1.5 days after AMI. Transplantation of progenitor cells was associated with a significant increase in global left ventricular ejection fraction from 51.6+/-9.6% to 60.1+/-8.6% (P=0.003), improved regional wall motion in the infarct zone (-1.5+/-0.2 to -0.5+/-0.7 SD/chord; P<0.001), and profoundly reduced end-systolic left ventricular volumes (56.1+/-20 mL to 42.2+/-15.1 mL; P=0.01) at 4-month follow-up. In contrast, in a nonrandomized matched reference group, left ventricular ejection fraction only slightly increased from 51+/-10% to 53.5+/-7.9%, and end-systolic volumes remained unchanged. Echocardiography revealed a profound enhancement of regional contractile function (wall motion score index 1.4+/-0.2 at baseline versus 1.19+/-0.2 at follow-up; P<0.001). At 4 months, coronary blood flow reserve was significantly (P<0.001) increased in the infarct artery. Quantitative F-18-fluorodeoxyglucose-positron emission tomography analysis revealed a significant (P<0.01) increase in myocardial viability in the infarct zone. There were no differences for any measured parameter between blood-derived or bone marrow-derived progenitor cells. No signs of an inflammatory response or malignant arrhythmias were observed. CONCLUSIONS: In patients with AMI, intracoronary infusion of autologous progenitor cells appears to be feasible and safe and may beneficially affect postinfarction remodeling processes.
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Aßmus et al. (2002) conducted an RCT in Acute myocardial infarction (AMI) (n=20). Intracoronary infusion of autologous progenitor cells vs. Nonrandomized matched reference group was evaluated on Global left ventricular ejection fraction (p=0.003). Intracoronary infusion of autologous progenitor cells in patients with AMI increased global left ventricular ejection fraction from 51.6% to 60.1% at 4 months (P=0.003).
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