title: Determinants of functional recovery after myocardial infarction of patients treated with bone marrow-derived stem cells after thrombolytic therapy.
abstract: OBJECTIVE
  To assess the determinants of functional recovery in patients with ST-elevation myocardial infarction (STEMI) treated initially with thrombolysis, followed by percutaneous coronary intervention and intracoronary injection of bone marrow-derived stem cells (BMC).
  
  
  METHODS
  A randomised, placebo-controlled, double-blind study (substudy of FINCELL).
  
  
  METHODS
  Two tertiary cardiac centres.
  
  
  METHODS
  78 patients with STEMI randomly assigned to receive either intracoronary BMC (n=39) or placebo (n=39) into the infarct-related artery.
  
  
  METHODS
  Thrombolysis a few hours after symptom onset, percutaneous coronary intervention and intracoronary injection of BMC 2-6 days later.
  
  
  METHODS
  Efficacy of the BMC treatment was assessed by measurement of the change of global left ventricular ejection fraction (LVEF) from baseline to 6 months after STEMI. Various predefined variables (eg, the levels of certain natriuretic peptides and inflammatory cytokines) were analysed as determinants of improvement of LVEF.
  
  
  RESULTS
  In the BMC group, the most powerful determinant of the change in LVEF was the baseline LVEF (r=-0.58, p<0.001). Patients with baseline LVEF at or below the median (< or = 62.5%) experienced a more marked improvement in LVEF (+12.7 + or - 12.5 %units, p<0.001) than those above the median (-0.8 + or - 6.3 %units, p=0.10). Elevated N-terminal probrain natriuretic peptide (p<0.001) and N-terminal proatrial natriuretic peptide (p=0.052) levels were also associated with improvement in LVEF in the BMC group but not in the placebo group.
  
  
  CONCLUSIONS
  The global LVEF recovers most significantly after intracoronary infusion of BMC in patients with the most severe impairment of LVEF on admission. The baseline levels of natriuretic peptides seem also to be associated with LVEF recovery after BMC treatment. Trial registration ClinicalTrials.gov number, NCT00363324.
authors.affiliation: University of Oulu, Department of Internal Medicine. P.O. Box 5000 (Kajaanintie 50), FIN-90014 University of Oulu, Oulu, Finland. johanna.miettinen@oulu.fi
authors.forename: Johanna A
authors.initials: JA
authors.lastname: Miettinen
authors.forename: Kari
authors.initials: K
authors.lastname: Ylitalo
authors.forename: Pirjo
authors.initials: P
authors.lastname: Hedberg
authors.forename: Jari
authors.initials: J
authors.lastname: Jokelainen
authors.forename: Kari
authors.initials: K
authors.lastname: Kervinen
authors.forename: Matti
authors.initials: M
authors.lastname: Niemelä
authors.forename: Marjaana
authors.initials: M
authors.lastname: Säily
authors.forename: Pirjo
authors.initials: P
authors.lastname: Koistinen
authors.forename: Eeva-Riitta
authors.initials: ER
authors.lastname: Savolainen
authors.forename: Heikki
authors.initials: H
authors.lastname: Ukkonen
authors.forename: Mikko
authors.initials: M
authors.lastname: Pietilä
authors.forename: K E Juhani
authors.initials: KE
authors.lastname: Airaksinen
authors.forename: Juhani
authors.initials: J
authors.lastname: Knuuti
authors.forename: Olli
authors.initials: O
authors.lastname: Vuolteenaho
authors.forename: Timo H
authors.initials: TH
authors.lastname: Mäkikallio
authors.forename: Heikki V
authors.initials: HV
authors.lastname: Huikuri
mesh_terms: D000368:Aged; D009320:Atrial Natriuretic Factor / Q000378:metabolism; D015415:Biomarkers / Q000378:metabolism; D016026:Bone Marrow Transplantation; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D011498:Protein Precursors / Q000378:metabolism; D020127:Recovery of Function; D013318:Stroke Volume / Q000502:physiology; D015912:Thrombolytic Therapy
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; C099254:N-terminal proatrial natriuretic peptide; D010446:Peptide Fragments; D011498:Protein Precursors; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D009320:Atrial Natriuretic Factor