Systematic Review of the Effect of Intracoronary Autologous Bone Marrow Stem Cells Transfer on Left Ventricular Function after Acute Myocardial Infarction
Zhongshan Hospital, Shanghai, China
S.N. Zhang, A.J. Sun, J.B. Ge, K. Yao, Z.Y. Huang, K.Q. Wang, Y.Z. Zou
Background: Conflicting results existed now on the effect of intracoronary bone marrow stem cells (BMSC) transfer on left ventricular ejection fraction in patients with acute myocardial infarction. This study sought to analyze the efficacy of the procedure by performing a meta-analysis based on published randomised controlled trials.
Methods: A systematic literature search of PubMed, MEDLINE, BIOSIS, EBM Reviews and Chinese Journal Full-text Database between January 1990 and May 2007, was performed for relevant published studies. Inclusion criteria required that patients received intracoronary BMSCs transfer after coronary reperfusion therapy for primary acute myocardial infarction; study design involved patient randomization, double-blinding, and matching placebo; there is detailed data more than 3 months follow-up on left ventricular function available from the trials. Studies less than 10 subjects were excluded.
Results: A total of 7 trials with 545 patients were available for analysis. The mean increase in left ventricular ejection fraction between baseline and 4.9 months¡¯ follow-up after BMSC transfer was 8.89% (95%CI [ 3.42, 14.36] ; P = 0.001), and the effect of BMSC treatment on the change in left ventricular ejection fraction was an increase of 5.65% (95% CI [2.24, 9.06]; P=0.001). The pooled statistics showed the beneficial effect on left ventricular end-diastolic volume of baseline in BMSC group (P=0.01), and there was no significant difference between two groups (standardized mean difference 95%CI [£0.59, 0.12]; P=0.20). In BMSC group, there was no significant difference in left ventricular end-systolic volume between baseline and follow-up (P=0.33). However, compared with control, BMSC transfer significantly decreased left ventricular end-systolic volume (standardized mean difference 95%CI [£0.53, £0.09]; P=0.005).
Conclusion: BMSC transplantation significantly promotes the recovery of left ventricular ejection fraction and prevents left ventricular end-systolic volume enlargement but has no effects on left ventricular remodeling after acute myocardial infarction.
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