Absence of accelerated atherosclerotic disease progression after intracoronary infusion of bone marrow derived mononuclear cells in patients with acute myocardial infarction--angiographic and intravascular ultrasound--results from the TErapia Celular Aplicada al Miocardio Pilot study.
BACKGROUND
We tried to evaluate a putative negative effect on coronary atherosclerosis in patients receiving intracoronary infusion of unfractionated bone marrow mononuclear cells (BMMC) following an acute ST-elevation myocardial infarction. Peripheral blood mononuclear cells or enriched CD133(+) BMMC have been associated with accelerated atherosclerosis of the distal segment of the infarct related artery (IRA).


METHODS
Thirty-seven patients with ST-elevation myocardial infarction from the TECAM pilot study underwent intracoronary infusion of autologous BMMC 9 +/- 3.1 days after onset of symptoms. We compared angiographic changes from baseline to 9 months of follow-up in the distal non-stented segment of the IRA, as well as in the contralateral coronary artery, with a matched control group. A subgroup of 15 treated patients underwent additional IVUS within the distal segment of the IRA.


RESULTS
No difference between stem cell and control group were found regarding changes in minimum lumen diameter (0.006 +/- 0.42 vs 0.06 +/- 0.41 mm, P = ns) and the percentage of stenosis (-2.68 +/- 12.33% vs -1.78 +/- 8.75%, P = ns) at follow-up. Likewise, no differences were seen regarding changes in the contralateral artery (minimum lumen diameter -0.004 +/- 0.54 mm vs -0.06 +/- 0.35 mm, P = ns). In the intravascular ultrasound substudy, no changes were demonstrated comparing baseline versus follow-up in maximum area stenosis and plaque volume.


CONCLUSIONS
In this pilot study, analysis of a subgroup of patients found that intracoronary injection of unfractionated BMMC in patients with acute ST-elevation myocardial infarction was not associated with accelerated atherosclerosis progression at mid term. Prospective, randomised studies in large cohorts with long-term angiographic and intravascular ultrasound follow-up are necessary to determine the safety of this therapy.
Arnold
Roman
R
Institute of Heart Sciences (ICICOR), Hospital Clínico Universitario, Valladolid, Spain. roman.arnold@hotmail.com
Villa
Adolfo
A
Gutiérrez
Hipólito
H
Sánchez
Pedro L
PL
Gimeno
Federico
F
Fernández
Maria E
ME
Gutiérrez
Oliver
O
Mota
Pedro
P
Sánchez
Ana
A
García-Frade
Javier
J
Fernández-Avilés
Francisco
F
San Román
Jose A
JA
D050197:Atherosclerosis / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D016913:Blood Component Transfusion / Q000379:methods*; D001804:Blood Transfusion, Autologous; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003331:Coronary Vessels; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007261:Infusions, Intra-Arterial; D008264:Macrophages / Q000637:transplantation*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D010865:Pilot Projects; D012189:Retrospective Studies; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*