Key result
Intracoronary bone marrow cell therapy improves LVEF by ~3% absolute vs controls after STEMI.
Why the study?
The study was conducted to systematically examine the effect of intracoronary bone marrow cell therapy on left ventricular function after ST-segment elevation myocardial infarction across various patient subgroups.
Does intracoronary bone marrow cell therapy improve left ventricular function in patients with ST-segment elevation myocardial infarction?
Meta-Analysis (n=1,641)
Yes
Does intracoronary bone marrow cell therapy improve left ventricular function in patients with ST-segment elevation myocardial infarction?
Mean Difference: 2.55 (95% CI 1.83–3.26)
p-value: p=< 0.001
Intracoronary bone marrow cell infusion after STEMI is associated with a modest but significant improvement in left ventricular ejection fraction and remodeling, particularly in younger patients and those with baseline LVEF <40%.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Interestingly, patients > 55 years appeared to benefit from the administration of cells in terms of effects on LVEF, although not on LVEDVI or LVESVI. Patients enrolled in these studies were young and the effect of age on stem cell function is an important one, as the authors point out. We can expect clarification of age-related effects from BAMI, which has placed no upper limit on age to qualify.”
“In this collaborative meta-analysis, we found that autologous bone marrow stem cell infusion is associated with a moderate but statistically significant improvement of LV systolic function and remodeling in patients after STEMI. This is reflected by a larger increase in LVEF and a greater decrease in LVESVI and LVEDVI in the treated population. In additional subgroup analyses, younger patients and patients with more depressed LVEF at baseline had the largest benefit from bone marrow stem cell infusion.”
Intracoronary BMC therapy may improve LV recovery post-STEMI; confirms benefit across subgroups in this RCT meta-analysis.
AIMS: The objective of the present analysis was to systematically examine the effect of intracoronary bone marrow cell (BMC) therapy on left ventricular (LV) function after ST-segment elevation myocardial infarction in various subgroups of patients by performing a collaborative meta-analysis of randomized controlled trials. METHODS AND RESULTS: We identified all randomized controlled trials comparing intracoronary BMC infusion as treatment for ST-segment elevation myocardial infarction. We contacted the principal investigator for each participating trial to provide summary data with regard to different pre-specified subgroups [age, diabetes mellitus, time from symptoms to percutaneous coronary intervention, infarct-related artery, LV end-diastolic volume index (EDVI), LV ejection fraction (EF), infarct size, presence of microvascular obstruction, timing of cell infusion, and injected cell number] and three different endpoints [change in LVEF, LVEDVI, and LV end-systolic volume index (ESVI)]. Data from 16 studies were combined including 1641 patients (984 cell therapy, 657 controls). The absolute improvement in LVEF was greater among BMC-treated patients compared with controls: [2.55% increase, 95% confidence interval (CI) 1.83-3.26, P < 0.001]. Cell therapy significantly reduced LVEDVI and LVESVI (-3.17 mL/m², 95% CI: -4.86 to -1.47, P < 0.001; -2.60 mL/m², 95% CI -3.84 to -1.35, P < 0.001, respectively). Treatment benefit in terms of LVEF improvement was more pronounced in younger patients (age <55, 3.38%, 95% CI: 2.36-4.39) compared with older patients (age ≥ 55 years, 1.77%, 95% CI: 0.80-2.74, P = 0.03). This heterogeneity in treatment effect was also observed with respect to the reduction in LVEDVI and LVESVI. Moreover, patients with baseline LVEF <40% derived more benefit from intracoronary BMC therapy. LVEF improvement was 5.30%, 95% CI: 4.27-6.33 in patients with LVEF <40% compared with 1.45%, 95% CI: 0.60 to 2.31 in LVEF ≥ 40%, P < 0.001. No clear interaction was observed between other subgroups and outcomes. CONCLUSION: Intracoronary BMC infusion is associated with improvement of LV function and remodelling in patients after ST-segment elevation myocardial infarction. Younger patients and patients with a more severely depressed LVEF at baseline derived most benefit from this adjunctive therapy.
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Delewi et al. (2013) conducted a meta-analysis in ST-segment elevation myocardial infarction (n=1,641). Intracoronary bone marrow cell (BMC) therapy vs. Controls was evaluated on Change in left ventricular ejection fraction (LVEF) (Absolute improvement 2.55%, 95% CI 1.83-3.26, p=< 0.001). Intracoronary bone marrow cell therapy significantly improved left ventricular ejection fraction by an absolute 2.55% (95% CI 1.83-3.26; P<0.001) compared with controls after STEMI.
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