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 (PCI) and intracoronary injection of bone marrow derived stem cells (BMC).
Design: Randomised, placebo-controlled, double-blind study (sub-study 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, PCI and intracoronary injection of BMC two to six 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 six months after STEMI. Various pre-defined variables (e.g. the levels of certain natriuretic peptides and inflammatory cytokines) were analyzed as determinants of improvement of LVEF.
Results: In the BMC group, the most powerful determinant of the change of LVEF was the baseline LVEF (r = -0.58, p<0.001). Patients with baseline LVEF at or below median (≤62.5%) experienced a more marked improvement of LVEF (+12.7 ± 12.5 %units, P<0.001) than those above 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 of LVEF in the BMC group but not in the placebo group.
Conclusions: The global LVEF recovers most significantly after intracoronary infusion of BMCs in patients who have 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.
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