title: Results of intracoronary stem cell therapy after acute myocardial infarction.
abstract: To assess the effect of autologous bone-marrow cell (BMC) therapy in patients with acute myocardial infarction in a rigorous double-blind, randomized, placebo-controlled trial. Patients with reperfusion >6 hours after symptom onset were randomly assigned in a 2:1 ratio to receive intracoronary BMC or placebo therapy 5 to 7 days after symptom onset. The patients were stratified according to age, acute myocardial infarction localization, and left ventricular (LV) function. Rigorous double-blinding was ensured using autologous erythrocytes for the placebo preparation that was visually indistinguishable from the active treatment. Serial cardiac magnetic resonance imaging studies were performed before study therapy and after 1, 3, and 6 months. The primary end point was the difference in the LV ejection fraction from baseline to 6 months. The secondary end points included changes in the LV end-diastolic and end-systolic volume indexes and infarct size. A total of 42 patients were enrolled (29 in the BMC group and 13 in the placebo group) in the integrated pilot phase. A mean of 381 x 10(6) mononuclear BMCs were administered. The baseline clinical and cardiac magnetic resonance imaging parameters did not differ. Compared to baseline, the difference in LV ejection fraction for the placebo group versus BMC group was 1.7 +/- 6.4% versus -0.9 +/- 5.5% at 1 month, 3.1 +/- 6.0% versus 1.9 +/- 4.3% at 3 months, and 5.7 +/- 8.4% versus 1.8 +/- 5.3% at 6 months (primary end point; not significant). No difference was found in the secondary end points between the 2 groups, including changes in infarct size or LV end-diastolic and end-systolic volume indexes. In conclusion, in this rigorous double-blind, randomized, placebo-controlled trial, we did not observe an evidence for a positive effect for intracoronary BMC versus placebo therapy with respect to LV ejection fraction, LV volume indexes, or infarct size.
authors.affiliation: University of Ulm, Clinic for Internal Medicine II, Ulm, Germany. jochen.woehrle@uniklinik-ulm.de
authors.forename: Jochen
authors.initials: J
authors.lastname: Wöhrle
authors.forename: Nico
authors.initials: N
authors.lastname: Merkle
authors.forename: Volker
authors.initials: V
authors.lastname: Mailänder
authors.forename: Thorsten
authors.initials: T
authors.lastname: Nusser
authors.forename: Peter
authors.initials: P
authors.lastname: Schauwecker
authors.forename: Fabian
authors.initials: F
authors.lastname: von Scheidt
authors.forename: Klaus
authors.initials: K
authors.lastname: Schwarz
authors.forename: Martin
authors.initials: M
authors.lastname: Bommer
authors.forename: Markus
authors.initials: M
authors.lastname: Wiesneth
authors.forename: Hubert
authors.initials: H
authors.lastname: Schrezenmeier
authors.forename: Vinzenz
authors.initials: V
authors.lastname: Hombach
mesh_terms: D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D033581:Stem Cell Transplantation; D013318:Stroke Volume; D016277:Ventricular Function, Left