Impact of intracoronary cell therapy on left ventricular function in the setting of acute myocardial infarction: A collaborative systematic review and meta-analysis of controlled clinical trials
Impact of intracoronary cell therapy on left ventricular function in the setting of acute myocardial infarction: A collaborative systematic review and meta-analysis of controlled clinical trials
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DOI：
10.1016/j.jacc.2007.07.041
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发表时间：
2007-10-30
影响因子：
24
通讯作者：
Vetrovec, George W.
中科院分区：
文献类型：
--
作者：
Lipinski, Michael J.;Biondi-Zoccai, Giuseppe G. L.;Vetrovec, George W.
目的 我们的目的是对急性心肌梗死 (AMI) 后冠状动脉内细胞治疗的临床试验进行荟萃分析。背景 冠状动脉内细胞治疗在 AMI 的情况下继续进行评估，对左心室射血分数 (LVEF) 具有不同的影响。方法我们检索了 CENTRAL、mRCT 和 PubMed 数据库，以查找报告近期 AMI（= 3 个月）患者进行冠状动脉内细胞治疗的对照试验。 LVEF 和次要终点是梗死面积、心脏尺寸和二分临床结果的变化。 结果 检索了 10 项研究（698 名患者，中位随访 6 个月），并根据随机效应进行汇总。接受冠状动脉内细胞治疗的受试者 LVEF 显着改善（增加 3.0% [95% 置信区间 (CI) 1.9 至 4.1]；p < 0.001），并且 LVEF 显着改善。梗死面积（-5.6% [95% CI -8.7 至 -2.5]；p < 0.001）和收缩末期容积（-7.4 ml [95% CI -12.2 至 -2.71；p = 0.002），以及舒张末期容积减少的趋势（-4.6 ml [95% CI -10.4 至 1.1]；p =冠状动脉内细胞治疗还与名义上显着减少 AMI 复发率 (p = 0.04) 以及减少死亡、心力衰竭再住院和重复血运重建的趋势相关，表明注射细胞体积和 LVEF 变化之间存在剂量反应关系 (p = 0.066)。 结论 AMI 经皮冠状动脉介入治疗后的冠状动脉内细胞治疗似乎提供了统计学上和这些数据证实了这种新型疗法的有益影响，并支持进一步的多中心随机试验，旨在解决冠状动脉内细胞疗法对总体和无事件长期生存的影响。
Objectives We aimed to perform a meta-analysis of clinical trials on intracoronary cell therapy after acute myocardial infarction (AMI).Background Intracoronary cell therapy continues to be evaluated in the setting of AMI with variable impact on left ventricular ejection fraction (LVEF).Methods We searched the CENTRAL, mRCT, and PubMed databases for controlled trials reporting on intracoronary cell therapy performed in patients with a recent AMI (= 3 months. The primary end point was change in LVEF, and secondary end points were changes in infarct size, cardiac dimensions, and dichotomous clinical outcomes.Results Ten studies were retrieved (698 patients, median follow-up 6 months), and pooling was performed with random effect. Subjects that received intracoronary cell therapy had a significant improvement in LVEF (3.0% increase [95% confidence interval (CI) 1.9 to 4.1]; p < 0.001), as well as a reduction in infarct size (-5.6% [95% CI -8.7 to -2.5]; p < 0.001) and end-systolic volume (-7.4 ml [95% CI -12.2 to -2.71; p = 0.002), and a trend toward reduced end-diastolic volume (-4.6 ml [95% CI -10.4 to 1.1]; p = 0.11). Intracoronary cell therapy was also associated with a nominally significant reduction in recurrent AMI (p = 0.04) and with trends toward reduced death, rehospitalization for heart failure, and repeat revascularization. Meta-regression suggested the existence of a dose-response association between injected cell volume and LVEF change (p = 0.066).Conclusions Intracoronary cell therapy following percutaneous coronary intervention for AMI appears to provide statistically and clinically relevant benefits on cardiac function and remodeling. These data confirm the beneficial impact of this novel therapy and support further multicenter randomized trials targeted to address the impact of intracoronary cell therapy on overall and event-free long-term survival.