title: Intramyocardial Autologous Bone Marrow-derived Stem Cells Injection for Ischemic Heart Disease Ineligible for Revascularization: A Systematic Review and Meta-analysis.
abstract: OBJECTIVE
  Intramyocardial autologous bone marrow-derived stem cells injection (IM-BMCs) has been used in patients with ischemic heart disease (IHD) who are ineligible for revascularization; however, the procedure has yielded mixed results. The objective of this meta-analysis was to evaluate the safety and therapeutic benefits of this treatment on a relatively large scale.
  
  
  METHODS
  PubMed, EMBASE, and Cochrane Library databases through September 2014 were searched for randomized clinical trials (RCTs) of IM-BMCs to treat IHD. Outcome measures were defined as mortality after treatment, change in left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV) and left ventricular end-diastolic volume (LVEDV). Weighted mean differences for the changes were estimated with a random-effects model.
  
  
  RESULTS
  Nine RCTs were eligible for inclusion. IM-BMCs significantly reduced the risk of mortality (RR, 0.33; 95% CI, 0.17-0.65; p = 0.001). IM-BMCs significantly improved LVEF by 2.57% (95% CI, 0.34-4.80%; p = 0.02) and reduced LVESV by 9.67 mL (95% CI, -16.43 mL to -2.91 mL; p = 0.005). No significant improvement in LVEDV (WMD = 4.73 mL; 95% CI, -7.22 mL to 16.68 mL; p = 0.44) was detected in patients who received IM-BMC therapy.
  
  
  CONCLUSIONS
  IM-BMC therapy showed clinical safety while being used as stand-alone treatment in IHD with no option of revascularization. The therapeutic efficacy requires further confirmation in large well-powered trials with long-term follow-up.
authors.affiliation: Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, PR China; Shanghai Institute of Cardiovascular Disease, Shanghai, PR China.
authors.forename: Kai
authors.initials: K
authors.lastname: Zhu
authors.affiliation: Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, PR China; Shanghai Institute of Cardiovascular Disease, Shanghai, PR China.
authors.forename: Jun
authors.initials: J
authors.lastname: Li
authors.affiliation: Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, PR China; Shanghai Institute of Cardiovascular Disease, Shanghai, PR China.
authors.forename: Yulin
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Health Statistics and Social Medicine, School of Public Health, Fudan University, Shanghai, PR China.
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Luo
authors.affiliation: Department of Biostatistics, School of Public Health, Fudan University, Shanghai, PR China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, PR China; Shanghai Institute of Cardiovascular Disease, Shanghai, PR China.
authors.forename: Changfa
authors.initials: C
authors.lastname: Guo
authors.affiliation: Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, PR China; Shanghai Institute of Cardiovascular Disease, Shanghai, PR China. Electronic address: lai.hao@zs-hospital.sh.cn.
authors.forename: Hao
authors.initials: H
authors.lastname: Lai
authors.affiliation: Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, PR China; Shanghai Institute of Cardiovascular Disease, Shanghai, PR China. Electronic address: wang.chunsheng@zs-hospital.sh.cn.
authors.forename: Chunsheng
authors.initials: C
authors.lastname: Wang
mesh_terms: D001854:Bone Marrow Cells; D016026:Bone Marrow Transplantation; D006801:Humans; D007273:Injections, Intramuscular; D017202:Myocardial Ischemia / Q000628:therapy*; D013234:Stem Cells; D014182:Transplantation, Autologous
keywords: Bone marrow-derived stem cells; Ineligible; Intramyocardial injection; Ischemic heart disease; Revascularization