Clinical Outcome 2 Years After Intracoronary Administration of Bone Marrow-Derived Progenitor Cells in Acute Myocardial Infarction

被引:199
作者
Assmus, Birgit [1 ]
Rolf, Andreas [4 ]
Erbs, Sandra [5 ]
Elsaesser, Albrecht [6 ]
Haberbosch, Werner [7 ]
Hambrecht, Rainer [8 ]
Tillmanns, Harald [9 ]
Yu, Jiangtao [10 ]
Corti, Roberto [11 ]
Mathey, Detlef G. [12 ]
Hamm, Christian W. [4 ]
Sueselbeck, Tim [13 ]
Tonn, Torsten [3 ]
Dimmeler, Stefanie [2 ]
Dill, Thorsten [4 ]
Zeiher, Andreas M. [1 ]
Schaechinger, Volker [1 ]
机构
[1] Goethe Univ Frankfurt, Div Cardiol, D-60590 Frankfurt, Germany
[2] Goethe Univ Frankfurt, Div Mol Cardiol, D-60590 Frankfurt, Germany
[3] Goethe Univ Frankfurt, Inst Transfus Med, D-60590 Frankfurt, Germany
[4] Max Planck Inst Physiol & Clin Res, Kerckhoff Klin, D-6350 Bad Nauheim, Germany
[5] Herzzentrum Leipzig, Leipzig, Germany
[6] Klinikum Oldenburg, Div Cardiol, Oldenburg, Germany
[7] Zent Klinikum Suhl, Div Cardiol, Suhl, Germany
[8] Klinikum Links Weser, Div Cardiol, Bremen, Germany
[9] Univ Giessen Klinikum, Div Cardiol, D-6300 Giessen, Germany
[10] Zent Klinkum Bad Berka, Div Cardiol, Bad Berka, Germany
[11] Univ Spital Zurich, Div Cardiol, Zurich, Switzerland
[12] Univ Hamburg, Ctr Cardiovasc, Hamburg, Germany
[13] Univ Klinikum Mannheim, Div Cardiol, Mannheim, Germany
关键词
myocardial infarction; prognosis; stem cells; heart failure; REPAIR-AMI TRIAL; CARDIAC REPAIR;
D O I
10.1161/CIRCHEARTFAILURE.108.843243
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-The aim of this study was to investigate the clinical outcome 2 years after intracoronary administration of autologous progenitor cells in patients with acute myocardial infarction (AMI). Methods and Results-Using a double-blind, placebo-controlled, multicenter trial design, we randomized 204 patients with successfully reperfused AMI to receive intracoronary infusion of bone marrow-derived progenitor cells (BMC) or placebo medium into the infarct artery 3 to 7 days after successful infarct reperfusion therapy. At 2 years, the cumulative end point of death, myocardial infarction, or necessity for revascularization was significantly reduced in the BMC group compared with placebo (hazard ratio, 0.58; 95% CI, 0.36 to 0.94; P=0.025). Likewise, the combined end point death and recurrence of myocardial infarction and rehospitalization for heart failure, reflecting progression toward heart failure, was significantly reduced in the BMC group (hazard ratio, 0.26; 95% CI, 0.085 to 0.77; P=0.015). Intracoronary administration of BMC remained a significant predictor of a favorable clinical outcome by Cox regression analysis when adjusted for classical predictors of poor outcome after AMI. There was no evidence of increased restenosis or atherosclerotic disease progression after BMC therapy nor any evidence of increased ventricular arrhythmias or neoplasms. In addition, regional left ventricular contractility of infarcted segments, as assessed by MRI in a subgroup of patients at 2-year follow-up, was significantly higher in the BMC group compared with the placebo group (P<0.001). Conclusions-Intracoronary administration of BMC is associated with a significant reduction of the occurrence of major adverse cardiovascular events maintained for 2 years after AMI. Moreover, functional improvements after BMC therapy may persist for at least 2 years. Larger studies focusing on clinical event rates are warranted to confirm the effects of BMC administration on mortality and progression of heart failure in patients with AMIs.
引用
收藏
页码:89 / 96
页数:8
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