Intracoronary Autologous Bone Marrow-Derived Cell Therapy in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Q: What are the key findings of this study?

Intracoronary autologous bone marrow-derived cell therapy improved LVEF by +1.60% (95% CI 0.72-2.47, p<0.001) compared to standard care after acute myocardial infarction.

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Acute Myocardial Infarction (n=738). Intervention: Intracoronary autologous bone marrow-derived cell therapy vs. Standard care or placebo infusion. Primary outcome: Change from baseline in Left Ventricular Ejection Fraction (LVEF) at 6 to 12 months (MD +1.60%, 95% CI 0.72-2.47, p=<0.001).

Q: What question did this study set out to answer?

To evaluate the efficacy and safety of intracoronary autologous bone marrow-derived cell therapy compared with standard care in patients following acute myocardial infarction.

Mohammad Alzahrani

doi:10.47310/jpms2026150912

October 5, 2026Journal of Pioneering Medical ScienceOpen Access

Intracoronary Autologous Bone Marrow-Derived Cell Therapy in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

View Full Paper

Ask AI

Bookmark

Share

Key result

Intracoronary bone marrow cell therapy improves post-MI LVEF by ~1.6 percentage points vs standard care.

MD +1.60%
95% CI 0.72-2.47
P<0.001
n=738

Why the study?

Intracoronary autologous bone marrow-derived cell therapy has been proposed to enhance myocardial repair after AMI, but included cell products and trial designs vary considerably across the randomized controlled trial literature.

Does intracoronary infusion of autologous bone marrow-derived cells improve left ventricular ejection fraction in adult patients with acute myocardial infarction treated with primary or early PCI?

Key Points

To evaluate the efficacy and safety of intracoronary autologous bone marrow-derived cell therapy compared with standard care in patients following acute myocardial infarction.
Systematic review and random-effects meta-analysis searching PubMed, Embase, Cochrane CENTRAL, Scopus, and Web of Science through 2025 without prospective registration.
Included 6 randomized controlled trials (N=738 total: 411 cell therapy, 327 control) evaluating autologous bone marrow mononuclear cells or combinations against standard care.
Study selection, data extraction, and Cochrane RoB 2.0 risk of bias assessment were conducted by a single reviewer.
Cell therapy produced a small improvement in left ventricular ejection fraction compared to control (MD +1.60%; 95% CI 0.72-2.47; p<0.001; I² = 0%).
No significant differences were identified for all-cause mortality (RR 0.94; 95% CI 0.71-1.25), major adverse cardiac events (RR 0.89; 95% CI 0.68-1.16), or infarct size (MD -1.5%; 95% CI -3.8 to 0.8).
Certainty of evidence evaluated by GRADE ranged from low to very low across outcomes, driven primarily by risk of bias and imprecision.

Study Design

Type

Meta-Analysis (n=738)

Blinding

Mixed (Double-blind to Open-label)

Randomization

Randomized controlled trials

Multicenter

Yes

Structured PICO

Does intracoronary infusion of autologous bone marrow-derived cells improve left ventricular ejection fraction in adult patients with acute myocardial infarction treated with primary or early PCI?

P

Population

738 adult patients across 6 RCTs with acute myocardial infarction treated with primary or early PCI, receiving intracoronary cell infusion within 3-8 days and followed for 4 to 12 months.

I

Intervention

Intracoronary infusion of autologous bone marrow-derived cells (unselected bone marrow mononuclear cells [BMMNC], BMMNC/peripheral blood mononuclear cell mixtures, or selected CD34+/CXCR4+ combined with unselected BMMNC) administered within approximately 3 to 8 days of the index event.

C

Comparator

Standard care or placebo-infusion control arm following primary or early PCI for acute myocardial infarction.

O

Outcome

Between-group mean difference in Left Ventricular Ejection Fraction (LVEF) change from baseline to the trial's primary follow-up timepoint (pooled across the 6 to 12-month follow-up window), assessed by quantitative left ventriculography, cardiac MRI, echocardiography, or SPECT.surrogate

Main Result

Mean Difference: 1.6 (95% CI 0.72–2.47)

p-value: p=<0.001

Limitations

Small number of included trials (six RCTs) restricting statistical power and rendering publication-bias assessments underpowered
Study selection, data extraction, and risk-of-bias assessments were performed by a single reviewer
Review protocol was not prospectively registered in PROSPERO or an equivalent registry
Clinical and methodological heterogeneity across trials in cell products, delivery timing (3 to 8 days), LVEF imaging modalities, and follow-up duration (4 to 12 months)
High risk of bias in earlier included trials (BOOST and ASTAMI) due to lack of blinding and open-label outcome assessment
Secondary outcomes (mortality, MACE, infarct size) were not fully re-derived from arm-level data
Inclusion of only six RCTs severely restricts overall statistical power, precluding meaningful meta-regression and rendering publication-bias assessments underpowered.
Study selection, data extraction, and risk-of-bias assessments were conducted by a single reviewer rather than independently by two reviewers.
The review protocol was not prospectively registered in PROSPERO, INPLASY, or an equivalent registry prior to data extraction.
Notable clinical and follow-up heterogeneity across trials regarding cell products, administration timing (3 to 8 days), LVEF assessment modalities (ventriculography, MRI, SPECT, echocardiography), and follow-up durations (4 to 12 months).
Secondary outcomes including mortality, MACE, infarct size, and long-term (>12-month) LVEF estimates require independent verification before definitive clinical conclusions can be drawn.

Implication

Intracoronary autologous bone marrow-derived cell therapy after acute myocardial infarction yields a small statistically significant increase in LVEF (+1.60%) of uncertain clinical relevance without improving mortality, MACE, or infarct size.

Abstract

Background: Intracoronary autologous bone marrow-derived cell therapy has been proposed to enhance myocardial repair after Acute Myocardial Infarction (AMI), but the included cell products and trial designs vary considerably across the RCT literature. Methods: PubMed, Embase, Cochrane CENTRAL, Scopus and Web of Science were searched from inception to 2025 for randomized controlled trials of intracoronary autologous bone marrow-derived cell therapy (Bone Marrow Mononuclear Cells [BMMNC], BMMNC/peripheral blood mononuclear cell mixtures, or selected CD34+/BMMNC combinations) versus standard care following AMI, reporting change in Left Ventricular Ejection Fraction (LVEF). Study selection, data extraction and Risk-of-Bias assessment (Cochrane RoB 2.0) were performed by a single reviewer. Random-effects meta-analysis (DerSimonian-Laird, with a Paule-Mandel estimator as a sensitivity analysis) was used to pool the Mean Difference (MD) in LVEF. This review was not prospectively registered. Results: Six RCTs (738 patients: 411 cell therapy, 327 control) met inclusion criteria. Pooled LVEF change favored cell therapy (MD +1.60%; 95% CI 0.72-2.47; I² = 0%), a result unchanged under the Paule-Mandel sensitivity estimator. No significant effects were observed for all-cause mortality (RR 0.94; 95% CI 0.71-1.25), major adverse cardiac events (MACE; RR 0.89; 95% CI 0.68-1.16), or infarct size (MD-1.5%; 95% CI-3.8 to 0.8). Certainty of evidence, graded by GRADE, ranged from low to very low across outcomes, driven primarily by risk of bias and imprecision. Conclusion: Intracoronary autologous bone marrow-derived cell therapy produces a small, statistically significant improvement in LVEF after AMI, without a demonstrated effect on mortality, MACE, or infarct size in this dataset. The clinical relevance of the LVEF effect remains uncertain and the certainty of the underlying evidence is low.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Mohammad Alzahrani (2026) conducted a meta-analysis in Acute Myocardial Infarction (n=738). Intracoronary autologous bone marrow-derived cell therapy vs. Standard care or placebo infusion was evaluated on Change from baseline in Left Ventricular Ejection Fraction (LVEF) at 6 to 12 months (MD +1.60%, 95% CI 0.72-2.47, p=<0.001). Intracoronary autologous bone marrow-derived cell therapy improved LVEF by +1.60% (95% CI 0.72-2.47, p<0.001) compared to standard care after acute myocardial infarction.

synapsesocial.com/papers/6ae28e38cbadf70daf6c4148 https://doi.org/10.47310/jpms2026150912

View Full Paper

Ask AI

Bookmark

Share

Intracoronary Autologous Bone Marrow-Derived Cell Therapy in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Intracoronary Autologous Bone Marrow-Derived Cell Therapy in Acute Myocardial Infarction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading