title: Long-Term Outcome of Combined (Percutaneous Intramyocardial and Intracoronary) Application of Autologous Bone Marrow Mononuclear Cells Post Myocardial Infarction: The 5-Year MYSTAR Study.
abstract: OBJECTIVE
  The long-term (5-year) outcome of early (3-6 weeks after acute myocardial infarction [AMI], BM-MNC Early group) and late (3-4 months after AMI, BM-MNC Late group) combined (percutaneous intramyocardial and intracoronary) delivery of autologous bone marrow mononuclear cells (BM-MNCs) was evaluated in patients with ejection fractions (EF) between 30-45% post-AMI.
  
  
  METHODS
  Major adverse cardiac and cerebrovascular events (MACCE) and hospitalization were recorded. Left (LV) and right (RV) ventricular function were measured by transthoracic echocardiography. Cardiac magnetic resonance imaging (MRI) and myocardial single photon emission computed tomography was performed in a subgroup of patients. Pre-cell therapy myocardial voltage values of treated areas (assessed by NOGA mapping) were correlated with clinical outcome.
  
  
  RESULTS
  Five-year MACCE incidences (7.4%. vs 24.1%) and the composite of all adverse events (11.1% vs 27.6%) were not different between the Early and Late treatment groups. The significant LV-EF increase at 1-year follow-up was preserved at the 5-year control (from baseline to 5-year: 5.3%, 95% CI:0.5-10.1, and 5.7%, 95% CI:1.7-9.6, p<0.05 in the Early and Late groups, respectively), with no significant changes between 1- and 5-year follow-ups. Similarly, RVEF increased significantly from baseline to the 5-year follow-up (Early group: 5.4%, 95% CI:1.0-9.6; and Late group: 8.4%, 95% CI:4.5-12.3). Lower baseline levels of myocardial viability of the treated cardiac area (6.3±2.4 vs 8.2±3.0 mV, p<0.05) were associated with incidence of MACCE.
  
  
  CONCLUSIONS
  Percutaneous combined delivery of autologous BM-MNCs is feasible and safe after 5 years, and may result in sustained improvement of cardiac function at 5 years in patients with low EF post-AMI (Clinicaltrials.gov NCT01395212).
authors.affiliation: Department of Cardiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Mariann
authors.initials: M
authors.lastname: Gyöngyösi
authors.affiliation: Department of Angiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Georgiana-Aura
authors.initials: GA
authors.lastname: Giurgea
authors.affiliation: Department of Cardiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Bonni
authors.initials: B
authors.lastname: Syeda
authors.affiliation: Department of Cardiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Silvia
authors.initials: S
authors.lastname: Charwat
authors.affiliation: Department of Cardiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Marzluf
authors.affiliation: Department of Cardiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Julia
authors.initials: J
authors.lastname: Mascherbauer
authors.affiliation: Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria.
authors.forename: Andras
authors.initials: A
authors.lastname: Jakab
authors.affiliation: Department of Cardiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Abelina
authors.initials: A
authors.lastname: Zimba
authors.affiliation: Metabolic Diseases and Cell Signaling Group, Department of Biochemistry, Faculty of Medicine, University of Szeged, Szeged, Hungary.
authors.forename: Márta
authors.initials: M
authors.lastname: Sárközy
authors.affiliation: Department of Cardiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Noemi
authors.initials: N
authors.lastname: Pavo
authors.affiliation: Department of Cardiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Heinz
authors.initials: H
authors.lastname: Sochor
authors.affiliation: Department of Cardiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Senta
authors.initials: S
authors.lastname: Graf
authors.affiliation: Department of Cardiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Irene
authors.initials: I
authors.lastname: Lang
authors.affiliation: Department of Cardiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.affiliation: Department of Cardiology, Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Jutta
authors.initials: J
authors.lastname: Bergler-Klein
mesh_terms: D000368:Aged; D001854:Bone Marrow Cells / Q000166:cytology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D007963:Leukocytes, Mononuclear / Q000166:cytology / Q000637:transplantation*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D009206:Myocardium / Q000473:pathology; D011446:Prospective Studies; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D016276:Ventricular Function / Q000502:physiology