Intracoronary autologous bone-marrow cell transfer after myocardial infarction: the BOOST randomised controlled clinical trial.
BACKGROUND
Emerging evidence suggests that stem cells and progenitor cells derived from bone marrow can be used to improve cardiac function in patients after acute myocardial infarction. In this randomised trial, we aimed to assess whether intracoronary transfer of autologous bone-marrow cells could improve global left-ventricular ejection fraction (LVEF) at 6 months' follow-up.


METHODS
After successful percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction, 60 patients were randomly assigned to either a control group (n=30) that received optimum postinfarction medical treatment, or a bone-marrow-cell group (n=30) that received optimum medical treatment and intracoronary transfer of autologous bone-marrow cells 4.8 days (SD 1.3) after PCI. Primary endpoint was global left-ventricular ejection fraction (LVEF) change from baseline to 6 months' follow-up, as determined by cardiac MRI. Image analyses were done by two investigators blinded for treatment assignment. Analysis was per protocol.


RESULTS
Global LVEF at baseline (determined 3.5 days [SD 1.5] after PCI) was 51.3 (9.3%) in controls and 50.0 (10.0%) in the bone-marrow cell group (p=0.59). After 6 months, mean global LVEF had increased by 0.7 percentage points in the control group and 6.7 percentage points in the bone-marrow-cell group (p=0.0026). Transfer of bone-marrow cells enhanced left-ventricular systolic function primarily in myocardial segments adjacent to the infarcted area. Cell transfer did not increase the risk of adverse clinical events, in-stent restenosis, or proarrhythmic effects.


CONCLUSIONS
Intracoronary transfer of autologous bone-marrow-cells promotes improvement of left-ventricular systolic function in patients after acute myocardial infarction.
Wollert
Kai C
KC
Department of Cardiology, Hanover Medical School, Hanover, Germany.
Meyer
Gerd P
GP
Lotz
Joachim
J
Ringes-Lichtenberg
Stefanie
S
Lippolt
Peter
P
Breidenbach
Christiane
C
Fichtner
Stephanie
S
Korte
Thomas
T
Hornig
Burkhard
B
Messinger
Diethelm
D
Arseniev
Lubomir
L
Hertenstein
Bernd
B
Ganser
Arnold
A
Drexler
Helmut
H
D015906:Angioplasty, Balloon, Coronary; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D003287:Contrast Media; D023903:Coronary Restenosis; D003331:Coronary Vessels; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D009206:Myocardium / Q000473:pathology; D015607:Stents; D013318:Stroke Volume; D016277:Ventricular Function, Left
D003287:Contrast Media