Impact of intracoronary cell therapy on left ventricular function in the setting of acute myocardial infarction: a meta-analysis of randomised controlled clinical trials
- Ronak Delewi1,2,
- Anouk Andriessen1,
- Jan G P Tijssen1,
- Felix Zijlstra3,
- Jan J Piek1,
- Alexander Hirsch1
- 1Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- 2Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands
- 3Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Correspondence to Dr Alexander Hirsch, Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands;
Contributors RD, the primary author, and AH, the senior author, performed all analyses and gave final approval for the paper. AA and JGPT contributed significantly to the analysis and interpretation of the data. JJP and FZ contributed to the drafting of the manuscript and provided critical revisions.
- Received 16 April 2012
- Revised 28 June 2012
- Accepted 2 July 2012
- Published Online First 8 August 2012
Context Numerous randomized controlled studies assessing intracoronary bone marrow cell therapy (BMC) after acute myocardial infarction (AMI) have been performed.
Objective To systematically review the effect of autologous BMC therapy on left ventricular function by performing an up to date meta-analysis of randomized controlled trials (RCTs) including long-term follow-up.
Data sources Trials were indentified through a literature search from 1980 to June 2012 of the Pubmed, Embase, Cochrane database, and the Current Controlled Trials Register.
Study selection Randomized clinical trials comparing intracoronary BMC infusion to control as treatment for AMI.
Data extraction The primary endpoint was the change in left ventricular ejection fraction (LVEF) from baseline to follow-up. Secondary endpoints were changes in left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), infarct size and clinical outcomes.
Results Improvement of LVEF in patients receiving intracoronary BMC was significantly better within 6 months (23 studies, 2.23% (95% confidence interval (CI) 1.00 to 3.47); p<0.001). At 12 months of follow-up, this effect sustained with 3.91% more LVEF improvement (11 studies, (95% CI 2.56 to 5.27), p<0.001). At long-term follow-up, we found a trend for better LVEF improvement in favor of cell therapy (7 studies, 1.90% (95% CI −0.43 to 4.23); p=0.11). There was no clear effect in infarct size or LVEDV. However, we found a significant reduction in LVESV at 6 months (−4.81 ml (95% CI −7.86 to −1.76); p<0.001 and at 12 months (−9.41 ml (95% CI −13.64 to −5.17); p<0.001). Moreover, there was a statistically significant decrease in recurrent AMI (Relative Risk (RR) 0.44 (95% CI 0.24 to 0.79); p=0.007), and readmission for heart failure, unstable angina or chest pain (RR 0.59 (95% CI 0.35 to 0.98); p=0.04) in favour of cell therapy.
Conclusion Intracoronary BMC treatment leads to a moderate improvement of LVEF and reduction of LVESV at 6 months that sustained at 12 months follow-up, without a clear significant effect on LVEDV, or infarct size. Furthermore, we found that intracoronary cell therapy is significantly associated with a reduction in recurrent AMI and readmission for heart failure, unstable angina or chest pain.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.