Determinants of functional recovery after myocardial infarction of patients treated with bone marrow-derived stem cells after thrombolytic therapy
- Johanna A Miettinen1,
- Kari Ylitalo1,
- Pirjo Hedberg2,
- Jari Jokelainen3,
- Kari Kervinen1,
- Matti Niemelä1,
- Marjaana Säily1,
- Pirjo Koistinen1,
- Eeva-Riitta Savolainen2,
- Heikki Ukkonen4,
- Mikko Pietilä4,
- K E Juhani Airaksinen4,
- Juhani Knuuti4,
- Olli Vuolteenaho5,
- Timo H Mäkikallio1,
- Heikki V Huikuri1
- 1Department of Internal Medicine, Division of Cardiology, University of Oulu, Oulu, Finland
- 2Department of Clinical Chemistry, University of Oulu, Oulu, Finland
- 3Department of Public Health Science and General Practice, University of Oulu and Unit of General Practice, Oulu University Hospital, Oulu, Finland
- 4Department of Internal Medicine, Division of Cardiology and PET-center, University of Turku, Turku, Finland
- 5Department of Physiology, University of Oulu, Oulu, Finland
- Correspondence to Johanna A Miettinen, University of Oulu, Department of Internal Medicine. P.O. Box 5000 (Kajaanintie 50), FIN-90014 University of Oulu, Oulu, Finland;
- Accepted 20 October 2009
- Published Online First 11 November 2009
Objective To assess the determinants of functional recovery in patients with ST-elevation myocardial infarction (STEMI) treated initially with thrombolysis, followed by percutaneous coronary intervention and intracoronary injection of bone marrow-derived stem cells (BMC).
Design A randomised, placebo-controlled, double-blind study (substudy of FINCELL).
Setting Two tertiary cardiac centres.
Participants 78 patients with STEMI randomly assigned to receive either intracoronary BMC (n=39) or placebo (n=39) into the infarct-related artery.
Interventions Thrombolysis a few hours after symptom onset, percutaneous coronary intervention and intracoronary injection of BMC 2–6 days later.
Main outcome measures Efficacy of the BMC treatment was assessed by measurement of the change of global left ventricular ejection fraction (LVEF) from baseline to 6 months after STEMI. Various predefined variables (eg, the levels of certain natriuretic peptides and inflammatory cytokines) were analysed as determinants of improvement of LVEF.
Results In the BMC group, the most powerful determinant of the change in LVEF was the baseline LVEF (r=−0.58, p<0.001). Patients with baseline LVEF at or below the median (≤62.5%) experienced a more marked improvement in LVEF (+12.7±12.5 %units, p<0.001) than those above the median (−0.8±6.3 %units, p=0.10). Elevated N-terminal probrain natriuretic peptide (p<0.001) and N-terminal proatrial natriuretic peptide (p=0.052) levels were also associated with improvement in LVEF in the BMC group but not in the placebo group.
Conclusions The global LVEF recovers most significantly after intracoronary infusion of BMC in patients with the most severe impairment of LVEF on admission. The baseline levels of natriuretic peptides seem also to be associated with LVEF recovery after BMC treatment.
Trial registration ClinicalTrials.gov number, NCT00363324.
- Acute coronary syndrome
- bone marrow stem cells
- left ventricular ejection fraction
- natriuretic peptides
Funding The study was supported by grants from the Medical Council of the Academy of Finland, Helsinki, Finland and the Finnish Foundation for Cardiovascular Research, Helsinki, Finland.
Competing interests None.
Ethics approval This study was conducted with the approval of the Ethical Committee of the Northern Ostrobothnia Hospital District.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.