Intracoronary Injection of Bone Marrow–Derived Mononuclear Cells Early or Late After Acute Myocardial Infarction: Effects on Global Left Ventricular Function
What is optimal timing for treatment with bone-marrow mononuclear cells (BM-MNCs) for improvement of left ventricular (LV) function following myocardial infarction (MI)?
A total of 200 patients with large, reperfused ST-segment elevation MIs (STEMIs) were randomized in a 1:1:1 pattern to either control, BM-MNC treatment early (5-7 days post MI), or BM-MNC treatment late (3-4 weeks post-MI) groups. Cardiac magnetic resonance imaging was performed at baseline and after 4 months. The primary endpoint was the change from baseline to 4 months in global LV ejection fraction (EF) between the control and two treatment groups.
The change in LVEF from baseline to 4 months was −0.4 ± 8.8%; (p = 0.74 vs. baseline) in the control group, 1.8 ± 8.4% (p = 0.12 vs. baseline) in the early group, and 0.8 ± 7.6% (p = 0.45 vs. baseline) in the late group.
Among patients with STEMI and LV dysfunction after successful reperfusion, intracoronary infusion of BM-MNC at either 5-7 days or 3-4 weeks after acute MI did not improve LV function at 4-month follow-up.
The effectiveness of cell-based therapy for recovery of myocardium following MI is controversial. The REPAIR-AMI trial demonstrated that timing of BMC treatment played a role in efficacy of treatment; however, the TIME/LateTIME trials showed no beneficial effect of either early or late BMC treatment. The current SWISS-AMI trial tested control, early, and late BMC treatment, and now confirms that this cell type does not improve LV function following MI. Other studies looking at long-term clinical outcomes and other cell types are ongoing.
Keywords: Myocardial Infarction, Follow-Up Studies, Bone Marrow, Ventricular Function, Left, Ventricular Dysfunction, Left, Magnetic Resonance Imaging
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