Autologous bone marrow stem cells to treat acute myocardial infarction: a systematic review.
OBJECTIVE
To provide systematic assessment of the safety and efficacy of autologous bone marrow-derived stem cell (BMSC) transplantation in acute myocardial infarction (AMI) based on clinical evidence.


RESULTS
The search strategy included MEDLINE, EMBASE, the Cochrane Library, and Current Controlled Trials Register through to August 2007 for randomized controlled trials of BMSC treatment for AMI. Thirteen trials (14 comparisons) with a total of 811 participants were included. Data were analysed using a random effects model. Overall, stem cell therapy improved left ventricular ejection fraction (LVEF) by 2.99% [95% confidence interval (CI), 1.26-4.72%, P = 0.0007], significantly reduced left ventricular end-systolic volume (LVESV) by 4.74 mL (95% CI, -7.84 to -1.64 mL, P = 0.003), and myocardial lesion area by 3.51% (95% CI, -5.91 to -1.11%, P = 0.004) compared with controls. Subgroup analysis revealed that there was statistical significant difference in LEVF in favour of BMSCs when cells were infused within 7 days following AMI and when the BMSC dose administered was higher than 10(8) BMSCs. In addition, there were trends in favour of benefit for most clinical outcomes examined, although it should be acknowledged that the 95%CI included no significant difference.


CONCLUSIONS
Stem cell treatment for AMI still holds promise. Clinically, these data suggest that improvement over conventional therapy can be achieved. Further, adequately powered trials using optimal dosing, longer term outcome assessments, more reliable, and more patient-centred outcomes are required.
Stem Cell Research Laboratory, NHS-Blood and Transplant, John Radcliffe Hospital, Headington, Oxford OX3 9BQ, UK. enca.martin-rendon@nbs.nhs.uk
Enca
E
Martin-Rendon
Susan J
SJ
Brunskill
Chris J
CJ
Hyde
Simon J
SJ
Stanworth
Anthony
A
Mathur
Suzanne M
SM
Watt
D016026:Bone Marrow Transplantation; D019317:Evidence-Based Medicine; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D033581:Stem Cell Transplantation; D016896:Treatment Outcome