ArticlesIntracoronary autologous bone-marrow cell transfer after myocardial infarction: the BOOST randomised controlled clinical trial
Introduction
Rapid reperfusion of the infarct-related coronary artery is of great importance in salvaging ischaemic myocardium and limiting the infarct size in patients with acute myocardial infarction. When done expeditiously and expertly, percutaneous transluminal coronary angioplasty with stent implantation is the method of choice to re-establish coronary flow.1 Unfortunately, myocardial necrosis starts rapidly after coronary occlusion, usually before reperfusion can be achieved.2 The loss of viable myocardium initiates a process of adverse left-ventricular remodelling, leading to chamber dilatation and contractile dysfunction in many patients.3 In this context, much interest has followed from experimental studies showing that cardiac transfer of unfractionated bone-marrow cells, or stem cells and progenitor cells derived from bone marrow can enhance functional recovery after acute myocardial infarction.4, 5 Based on these data, stem cells and progenitor cells derived from bone marrow have been proposed for use in the repair of cardiac tissue after acute myocardial infarction in patients.6, 7, 8
Early clinical investigations indicate that infusion of autologous bone-marrow cells into the infarct-related coronary artery is feasible after acute myocardial infarction.9, 10 However, because these studies were not randomised trials, the efficacy of intracoronary transfer of bone-marrow cells for functional recovery after acute myocardial infarction in patients has remained uncertain. We did a randomised controlled trial to assess the effect of intracoronary transfer of autologous bone-marrow cells on left-ventricular functional recovery in patients after acute myocardial infarction and successful percutaneous coronary intervention (PCI).
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Patients
Patients were eligible if they were admitted within 5 days of the onset of symptoms of a first ST-segment elevation myocardial infarction, had undergone successful PCI with stent implantation in the infarct-related artery, and had hypokinesia or akinesia involving more than two thirds of the left-ventricular anteroseptal, lateral, and/or inferior wall, as shown by angiography done immediately after PCI. We excluded patients who had multivessel coronary artery disease, pulmonary oedema,
Results
Between January, 2002, and May, 2003, 78 patients were informed about the trial. 65 patients were randomly allocated to treatment. After randomisation, five patients were withdrawn because they could not undergo cardiac MRI, either because of claustrophobia or severe obesity. The final cohort included 30 controls and 30 patients in the bone-marrow-cell group (figure 1). Table 1 shows patients' baseline characteristics. All patients received optimum postinfarction medical treatment (table 1).
Discussion
Our randomised controlled clinical trial addresses the effect of autologous bone-marrow-cell therapy on left-ventricular functional recovery after acute ST-segment elevation myocardial infarction. We have shown that infusion of autologous bone-marrow-cells into the infarct-related coronary artery during the early postinfarction period (4–8 days after symptom onset) improves recovery of global LVEF after 6 months.
In view of the size of our trial, subgroup analyses must be considered with
References (28)
- et al.
Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials
Lancet
(2003) - et al.
Cardiac remodeling: concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling
J Am Coll Cardiol
(2000) - et al.
The evolving concept of a stem cell: entity or function?
Cell
(2001) - et al.
Visualisation of presence, location, and transmural extent of healed Q-wave and non-Q-wave myocardial infarction
Lancet
(2001) - et al.
Delayed contrast-enhanced magnetic resonance imaging for the prediction of regional functional improvement after acute myocardial infarction
J Am Coll Cardiol
(2003) - et al.
Therapeutic angiogenesis for patients with limb ischaemia by autologous transplantation of bone-marrow cells: a pilot study and a randomised controlled trial
Lancet
(2002) - et al.
Effects of intracoronary infusion of peripheral blood stem-cells mobilised with granulocyte-colony stimulating factor on left ventricular systolic function and restenosis after coronary stenting in myocardial infarction: the MAGIC cell randomised clinical trial
Lancet
(2004) - et al.
Intra-coronary arterial injection of mesenchymal stromal cells and microinfarction in dogs
Lancet
(2004) - et al.
Selecting the best reperfusion strategy in ST-elevation myocardial infarction: it's all a matter of time
Circulation
(2003) - et al.
Bone marrow cells regenerate infarcted myocardium
Nature
(2001)
Implantation of bone marrow mononuclear cells into ischemic myocardium enhances collateral perfusion and regional function via side supply of angioblasts, angiogenic ligands, and cytokines
Circulation
Adult stem cells for tissue repair: a new therapeutic concept?
N Engl J Med
Adult stem cell therapy in perspective
Circulation
Repair of infarcted myocardium by autologous intracoronary mononuclear bone marrow cell transplantation in humans
Circulation
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