Intracoronary Stem Cell Infusion After Acute Myocardial Infarction A Meta-Analysis and Update on Clinical Trials
Intracoronary Stem Cell Infusion After Acute Myocardial Infarction A Meta-Analysis and Update on Clinical Trials
复制标题
DOI：
10.1161/circinterventions.113.001009
复制
发表时间：
2014-04-01
影响因子：
5.6
通讯作者：
Duckers, Henricus J.
中科院分区：
文献类型：
--
作者：
de Jong, Renate;Houtgraaf, Jaco H.;Duckers, Henricus J.
背景-几种基于细胞的治疗急性心肌梗死的方法已经在多个临床试验中进行了研究，但其益处仍然存在争议。本荟萃分析旨在评价骨髓源性单核细胞（BMMNC）治疗急性心肌梗死患者的疗效，而且还探索了新一代干细胞的作用。对2002年1月至2010年1月发表的研究干细胞治疗急性心肌梗死患者效果的随机对照试验进行分析。2013年9月。定义的终点是左心室（LV）射血分数、LV收缩末期和舒张末期容积、梗死面积和主要不良心血管事件发生率。此外，对BMMNC试验进行了几项亚组分析。总体而言，结合22项随机对照试验（RCT）的结果，LV射血分数增加+2.10%（95%置信区间[CI]，0.68-3.52; P=0.004），与对照组相比，（-4.05 mL; 95% CI，-6.91至-1.18; P=0.006）和梗死面积缩小（-2.69%; 95% CI，-4.83至-0.56; P=0.01）。然而，当仅分析使用MRI衍生终点的RCT（n=9）时，对心脏功能、体积或梗死面积没有影响。此外，没有有益的影响，可以检测到主要不良心脏和脑血管事件发生率BMMNC输液后，中位随访时间为6 months. Conclusions冠状动脉内输注BMMNC是安全的，但不增强心脏功能的MRI衍生参数，也没有改善临床结果。新的、可能更有效的干细胞正在该领域出现，但它们的临床疗效仍需在未来的试验中确定。
Background-Several cell-based therapies for adjunctive treatment of acute myocardial infarction have been investigated in multiple clinical trials, but the benefits still remain controversial. This meta-analysis aims to evaluate the efficacy of bone marrow-derived mononuclear cell (BMMNC) therapy in patients with acute myocardial infarction, but also explores the effect of newer generations of stem cells.Methods and Results-A random-effects meta-analysis was performed on randomized controlled trials investigating the effects of stem cell therapy in patients with acute myocardial infarction that were published between January 2002 and September 2013. The defined end points were left ventricular (LV) ejection fraction, LV end-systolic and end-diastolic volumes, infarct size, and major adverse cardiac and cerebrovascular event rates. Also, several subgroup analyses were performed on BMMNC trials. Overall, combining the results of 22 randomized controlled trials (RCTs), LV ejection fraction increased by +2.10% (95% confidence interval [CI], 0.68-3.52; P=0.004) in the BMMNC group as compared with controls, evoked by a preservation of LV end-systolic volume (-4.05 mL; 95% CI, -6.91 to -1.18; P=0.006) and a reduction in infarct size (-2.69%; 95% CI, -4.83 to -0.56; P=0.01). However, there is no effect on cardiac function, volumes, or infarct size, when only RCTs (n=9) that used MRI-derived end points were analyzed. Moreover, no beneficial effect could be detected on major adverse cardiac and cerebrovascular event rates after BMMNC infusion after a median follow-up duration of 6 months.Conclusions-Intracoronary infusion of BMMNC is safe, but does not enhance cardiac function on MRI-derived parameters, nor does it improve clinical outcome. New and possibly more potent stem cells are emerging in the field, but their clinical efficacy still needs to be defined in future trials.