title: Impact of intracoronary bone marrow cell therapy on left ventricular function in the setting of ST-segment elevation myocardial infarction: a collaborative meta-analysis.
abstract: OBJECTIVE
  The objective of the present analysis was to systematically examine the effect of intracoronary bone marrow cell (BMC) therapy on left ventricular (LV) function after ST-segment elevation myocardial infarction in various subgroups of patients by performing a collaborative meta-analysis of randomized controlled trials.
  
  
  RESULTS
  We identified all randomized controlled trials comparing intracoronary BMC infusion as treatment for ST-segment elevation myocardial infarction. We contacted the principal investigator for each participating trial to provide summary data with regard to different pre-specified subgroups [age, diabetes mellitus, time from symptoms to percutaneous coronary intervention, infarct-related artery, LV end-diastolic volume index (EDVI), LV ejection fraction (EF), infarct size, presence of microvascular obstruction, timing of cell infusion, and injected cell number] and three different endpoints [change in LVEF, LVEDVI, and LV end-systolic volume index (ESVI)]. Data from 16 studies were combined including 1641 patients (984 cell therapy, 657 controls). The absolute improvement in LVEF was greater among BMC-treated patients compared with controls: [2.55% increase, 95% confidence interval (CI) 1.83-3.26, P < 0.001]. Cell therapy significantly reduced LVEDVI and LVESVI (-3.17 mL/m², 95% CI: -4.86 to -1.47, P < 0.001; -2.60 mL/m², 95% CI -3.84 to -1.35, P < 0.001, respectively). Treatment benefit in terms of LVEF improvement was more pronounced in younger patients (age <55, 3.38%, 95% CI: 2.36-4.39) compared with older patients (age ≥ 55 years, 1.77%, 95% CI: 0.80-2.74, P = 0.03). This heterogeneity in treatment effect was also observed with respect to the reduction in LVEDVI and LVESVI. Moreover, patients with baseline LVEF <40% derived more benefit from intracoronary BMC therapy. LVEF improvement was 5.30%, 95% CI: 4.27-6.33 in patients with LVEF <40% compared with 1.45%, 95% CI: 0.60 to 2.31 in LVEF ≥ 40%, P < 0.001. No clear interaction was observed between other subgroups and outcomes.
  
  
  CONCLUSIONS
  Intracoronary BMC infusion is associated with improvement of LV function and remodelling in patients after ST-segment elevation myocardial infarction. Younger patients and patients with a more severely depressed LVEF at baseline derived most benefit from this adjunctive therapy.
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
authors.forename: Ronak
authors.initials: R
authors.lastname: Delewi
authors.forename: Alexander
authors.initials: A
authors.lastname: Hirsch
authors.forename: Jan G
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Volker
authors.initials: V
authors.lastname: Schächinger
authors.forename: Wojciech
authors.initials: W
authors.lastname: Wojakowski
authors.forename: Jérôme
authors.initials: J
authors.lastname: Roncalli
authors.forename: Svend
authors.initials: S
authors.lastname: Aakhus
authors.forename: Sandra
authors.initials: S
authors.lastname: Erbs
authors.forename: Birgit
authors.initials: B
authors.lastname: Assmus
authors.forename: Michal
authors.initials: M
authors.lastname: Tendera
authors.forename: R
authors.initials: R
authors.lastname: Goekmen Turan
authors.forename: Roberto
authors.initials: R
authors.lastname: Corti
authors.forename: Tim
authors.initials: T
authors.lastname: Henry
authors.forename: Patricia
authors.initials: P
authors.lastname: Lemarchand
authors.forename: Ketil
authors.initials: K
authors.lastname: Lunde
authors.forename: Feng
authors.initials: F
authors.lastname: Cao
authors.forename: Heikki V
authors.initials: HV
authors.lastname: Huikuri
authors.forename: Daniel
authors.initials: D
authors.lastname: Sürder
authors.forename: Robert D
authors.initials: RD
authors.lastname: Simari
authors.forename: Stefan
authors.initials: S
authors.lastname: Janssens
authors.forename: Kai C
authors.initials: KC
authors.lastname: Wollert
authors.forename: Michal
authors.initials: M
authors.lastname: Plewka
authors.forename: Stefan
authors.initials: S
authors.lastname: Grajek
authors.forename: Jay H
authors.initials: JH
authors.lastname: Traverse
authors.forename: Felix
authors.initials: F
authors.lastname: Zijlstra
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Piek
mesh_terms: D000328:Adult; D000368:Aged; D016026:Bone Marrow Transplantation / Q000379:methods*; D002306:Cardiac Volume / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left / Q000502:physiology
keywords: Bone marrow cells; Meta-analysis; ST-segment elevation myocardial infarction; Ventricular function
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