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Bone Marrow Mononuclear Cells Transfer for Patients after ST-Elevated Myocardial Infarction: A Meta-Analysis of Randomized Control Trials

Li Lin|Jingyi Zhang|Wenxia Zong
연세대학교의과대학 (Yonsei University College of Medicine)|2018.07|Yonsei Medical Journal|제59권 제5호|pp. 611-623|DOI 10.3349/ymj.2018.59.5.611

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키워드

ST elevation myocardial infarctionleft ventricular dysfunctionstroke volumebone marrow transplantation
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초록

Purpose: Results on the clinical utility of cell therapy for ST-elevated myocardial infarction (STEMI) are controversial. This studysought to analyze the efficacy of treatment with intracoronary bone marrow mononuclear cells (BMMC) on left ventricular (LV)function and remodeling and LV diastolic and systolic function in patients with STEMI. Materials and Methods: Literature search of PubMed and EMBASE databases between 2004 and 2017 was performed for randomizedcontrolled trials in STEMI patients who underwent successful percutaneous coronary intervention and received intracoronaryBMMC therapy. The defined end points were left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume(LVEDV), and left ventricular end-systolic volume (LVESV). Also, sensitivity analysis and several subgroup analyses basedon follow-up duration, timing of injection, doses of cells, and imaging modalities were conducted to strengthen the statistic powerof the study. Results: A total of 22 trials with 1360 patients were available for the current meta-analysis. The pooled statistics showed a significantimprovement in LVEF {2.58 [95% confidence interval (CI), 1.32, 3.84]; p<0.001}, LVEDV [-3.73, (95% CI, -6.94, -0.52), p=0.02],and LVESV [-4.67, (95% CI, -7.07, -2.28), p<0.001] in the BMMC group, compared with the control group. However, in sensitivityanalysis, a significant reduction in LVEDV disappeared, while the outcomes of LVEF and LVESV remained unchanged. The sameresults were presented in the subgroup analysis adjusting for imaging modalities and timing of cells injection. Conclusion: BMMC transplantation in patients with STEMI was found to lead to improvement in LVEF, LVEDV, and LVESV parameters,indicating that cell therapy has a potential beneficial effect on LV remodeling and function.

Abstract

Purpose: Results on the clinical utility of cell therapy for ST-elevated myocardial infarction (STEMI) are controversial. This studysought to analyze the efficacy of treatment with intracoronary bone marrow mononuclear cells (BMMC) on left ventricular (LV)function and remodeling and LV diastolic and systolic function in patients with STEMI. Materials and Methods: Literature search of PubMed and EMBASE databases between 2004 and 2017 was performed for randomizedcontrolled trials in STEMI patients who underwent successful percutaneous coronary intervention and received intracoronaryBMMC therapy. The defined end points were left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume(LVEDV), and left ventricular end-systolic volume (LVESV). Also, sensitivity analysis and several subgroup analyses basedon follow-up duration, timing of injection, doses of cells, and imaging modalities were conducted to strengthen the statistic powerof the study. Results: A total of 22 trials with 1360 patients were available for the current meta-analysis. The pooled statistics showed a significantimprovement in LVEF {2.58 [95% confidence interval (CI), 1.32, 3.84]; p<0.001}, LVEDV [-3.73, (95% CI, -6.94, -0.52), p=0.02],and LVESV [-4.67, (95% CI, -7.07, -2.28), p<0.001] in the BMMC group, compared with the control group. However, in sensitivityanalysis, a significant reduction in LVEDV disappeared, while the outcomes of LVEF and LVESV remained unchanged. The sameresults were presented in the subgroup analysis adjusting for imaging modalities and timing of cells injection. Conclusion: BMMC transplantation in patients with STEMI was found to lead to improvement in LVEF, LVEDV, and LVESV parameters,indicating that cell therapy has a potential beneficial effect on LV remodeling and function.

참고문헌 (42)

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