Original Article

Long term results after intracoronary injection of autologous mononuclear bone marrow cells in acute myocardial infarction. The ASTAMI randomized, controlled study.

Jan Otto Beitnes^1,*, Einar Hopp², Ketil Lunde¹, Svein Solheim³, Harald Arnesen³, Jan E Brinchmann⁴, Kolbjørn Forfang¹, Svend Aakhus¹

¹ Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway;
² Department of Radiology, Oslo University Hospital, Rikshospitalet, Norway;
³ Department of Cardiology, Oslo University Hospital, Ullevål, Norway;
⁴ Institute of Immunology, Oslo University Hospital, Rikshospitalet, Norway

Correspondence to: Jan Otto Beitnes, Dept. of Cardiology, Oslo University Hospital, Rikshospitalet, Rikshospitalet, Dept. of Cardiology, Oslo, 0027, Norway; jan.otto.beitnes{at}rikshospitalet.no

Accepted 8 September 2009

Objective: To investigate long term safety and efficacy after intracoronary injection of autologous mononuclear bone marrow cells (mBMCs) in acute myocardial infarction (AMI).

Design: Randomized, controlled trial.

Setting: Two university hospitals in Oslo, Norway.

Patients: Patients from the Autologous Stem cell Transplantation in Acute Myocardial Infarction (ASTAMI) study, were re- assessed 3 years after inclusion.

Interventions: 100 patients with anterior wall ST-elevation myocardial infarction treated with acute PCI were randomized to receive intracoronary injection of mBMCs (n=50) or not (n=50).

Main outcome measures: Change in left ventricular (LV) ejection fraction (primary). Change in exercise capacity (peak VO2) and quality of life (secondary). Infarct size (additional aim) and safety.

Results: The rates of adverse clinical events in the groups were low and equal. There were no significant differences between groups in change of global left ventricular (LV) systolic function by echocardiography or magnetic resonance imaging (MRI) during the follow-up. On exercise testing, the mBMC treated patients had larger improvement in exercise time from 2-3 weeks to 3 years (1.5 vs. 0.6 minutes, p=0.05), but the change in peak oxygen consumption did not differ (3.0 vs. 3.1 ml/kg/min, p=0.75).

Conclusion: Our results indicate that intracoronary mBMC treatment in AMI is safe also in the long term. A small improvement in exercise time in the mBMC group was found, but no other effects of treatment could be identified 3 years after cell therapy.

The study is registered at clinicaltrials.gov NCT 00199823.

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