Impact of intracoronary bone marrow cell therapy on left ventricular function in the setting of ST-segment elevation myocardial infarction: a collaborative meta-analysis

Autor: Svend Aakhus, Michal Plewka, Jan G.P. Tijssen, Jay H. Traverse, Wojciech Wojakowski, R. Goekmen Turan, Sandra Erbs, Alexander Hirsch, Robert D. Simari, Timothy D. Henry, Stefan Grajek, Daniel Sürder, Jan J. Piek, Michal Tendera, Heikki V. Huikuri, Kai C. Wollert, Volker Schächinger, Ronak Delewi, Feng Cao, Ketil Lunde, Felix Zijlstra, Roberto Corti, Birgit Assmus, Jerome Roncalli, Stefan Janssens, Patricia Lemarchand
Přispěvatelé: Cardiology, University of Zurich, Delewi, Ronak, Amsterdam Cardiovascular Sciences, Department of Cardiology, University of Amsterdam [Amsterdam] (UvA), Department of Medicine III, Goethe-Universität Frankfurt am Main, Third Division of Cardiology, Medical University of Silesia (SUM), Service de cardiologie [Toulouse], Hôpital de Rangueil, CHU Toulouse [Toulouse]-CHU Toulouse [Toulouse], Rikshospitalet-Oslo University Hospital [Oslo], Department of Internal Medicine/Cardiology, Universität Leipzig [Leipzig], Department of Internal Medicine, University Hospital Rostock, University hospital of Zurich [Zurich], Minneapolis Heart Institute, University of Minnesota [Twin Cities] (UMN), University of Minnesota System-University of Minnesota System-Abbott Northwestern Hospital, unité de recherche de l'institut du thorax UMR1087 UMR6291 (ITX), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Fourth Military Medical University (FMMU)-Xijing Hospital, University of Oulu, Cardiocentro Ticino [Lugano], Universität Zürich [Zürich] = University of Zurich (UZH), Mayo Graduate School of Medicine, Mayo Clinic, Gasthuisberg University Hospital, Division of Molecular and Translational Cardiology, Hannover Medical School [Hannover] (MHH), Chair and Department of Cardiology, Medical University of Łódź (MUL), First Department of Cardiology, Poznań University School of the Medical Sciences, Thorax center, Erasmus University Medical Center [Rotterdam] (Erasmus MC), Medical University of Silesia, Lemarchand, Patricia, Service Cardiologie [CHU Toulouse], Pôle Cardiovasculaire et Métabolique [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Unité de recherche de l'institut du thorax (ITX-lab)
Rok vydání: 2014
Předmět:
Adult
medicine.medical_specialty
Cardiac Volume
medicine.medical_treatment
Myocardial Infarction
Diastole
Infarction
610 Medicine & health
[SDV.BC]Life Sciences [q-bio]/Cellular Biology
030204 cardiovascular system & hematology
Ventricular Function
Left
Cell therapy
11171 Cardiocentro Ticino
2705 Cardiology and Cardiovascular Medicine
Ventricular Dysfunction
Left
03 medical and health sciences
0302 clinical medicine
SDG 3 - Good Health and Well-being
Internal medicine
Humans
ST segment
Medicine
Myocardial infarction
[SDV.BC] Life Sciences [q-bio]/Cellular Biology
Aged
Bone Marrow Transplantation
Randomized Controlled Trials as Topic
030304 developmental biology
0303 health sciences
Ejection fraction
Surrogate endpoint
business.industry
Percutaneous coronary intervention
Stroke Volume
Stroke volume
Middle Aged
medicine.disease
3. Good health
ST-segment elevation myocardial infarction
Treatment Outcome
Cardiology
ventricular function
Cardiology and Cardiovascular Medicine
business
metaanalysis
Zdroj: European Heart Journal, 35(15), 989-998. Oxford University Press
European heart journal, 35(15), 989-998. Oxford University Press
European Heart Journal
European Heart Journal, Oxford University Press (OUP): Policy B, 2014, 35 (15), pp.989-98. ⟨10.1093/eurheartj/eht372⟩
European Heart Journal, 2014, 35 (15), pp.989-98. ⟨10.1093/eurheartj/eht372⟩
ISSN: 0195-668X
1522-9645
DOI: 10.1093/eurheartj/eht372⟩
Popis: Aims The objective of the present analysis was to systematically examine the effect of intracoronary bone marrow cell (BMC) therapy on left ventricular (LV) function after ST-segment elevation myocardial infarction in various subgroups of patients by performing a collaborative meta-analysis of randomized controlled trials. Methods and results We identified all randomized controlled trials comparing intracoronary BMC infusion as treatment for ST-segment elevation myocardial infarction. We contacted the principal investigator for each participating trial to provide summary data with regard to different pre-specified subgroups [age, diabetes mellitus, time from symptoms to percutaneous coronary intervention, infarct-related artery, LV end-diastolic volume index (EDVI), LV ejection fraction (EF), infarct size, presence of microvascular obstruction, timing of cell infusion, and injected cell number] and three different endpoints [change in LVEF, LVEDVI, and LV end-systolic volume index (ESVI)]. Data from 16 studies were combined including 1641 patients (984 cell therapy, 657 controls). The absolute improvement in LVEF was greater among BMC-treated patients compared with controls: [2.55% increase, 95% confidence interval (CI) 1.83-3.26, P < 0.001]. Cell therapy significantly reduced LVEDVI and LVESVI (-3.17 mL/m(2), 95% CI: -4.86 to -1.47, P < 0.001; -2.60 mL/m(2), 95% CI -3.84 to -1.35, P < 0.001, respectively). Treatment benefit in terms of LVEF improvement was more pronounced in younger patients (age < 55, 3.38%, 95% CI: 2.36-4.39) compared with older patients (age >= 55 years, 1.77%, 95% CI: 0.80-2.74, P 0.03). This heterogeneity in treatment effect was also observed with respect to the reduction in LVEDVI and LVESVI. Moreover, patients with baseline LVEF, < 40% derived more benefit from intracoronary BMC therapy. LVEF improvement was 5.30%, 95% CI: 4.27-6.33 in patients with LVEF,40% compared with 1.45%, 95% CI: 0.60 to 2.31 in LVEF >= 40%, P < 0.001. Noclear interaction was observed between other subgroups and outcomes. Conclusion Intracoronary BMC infusion is associated with improvement of LV function and remodelling in patients after ST-segment elevation myocardial infarction. Younger patients and patients with a more severely depressed LVEF at baseline derived most benefit from this adjunctive therapy.
Databáze: OpenAIRE
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