Eur Heart J-2013-Delewi-eurheartj_eht372.pdf (original) (raw)

Aims 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. Methods and 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 improvementin 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 (23.17 mL/m2, 95% CI: 24.86 to 21.47, P , 0.001; 22.60 mL/m2, 95% CI 23.84 to 21.35, 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 ¼ 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.Noclear interactionwas observed between other subgroups and outcomes.