Yonsei Med J.  2018 Jul;59(5):611-623. 10.3349/ymj.2018.59.5.611.

Bone Marrow Mononuclear Cells Transfer for Patients after ST-Elevated Myocardial Infarction: A Meta-Analysis of Randomized Control Trials

• Zhang J
• Lin L
• Zong W

• KMID: 2412652
• DOI: http://doi.org/10.3349/ymj.2018.59.5.611

Abstract

PURPOSE
Results on the clinical utility of cell therapy for ST-elevated myocardial infarction (STEMI) are controversial. This study sought to analyze the efficacy of treatment with intracoronary bone marrow mononuclear cells (BMMC) on left ventricular (LV) function and remodeling and LV diastolic and systolic function in patients with STEMI.
MATERIALS AND METHODS
Literature search of PubMed and EMBASE databases between 2004 and 2017 was performed for randomized controlled trials in STEMI patients who underwent successful percutaneous coronary intervention and received intracoronary BMMC therapy. The defined end points were left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV), and left ventricular end-systolic volume (LVESV). Also, sensitivity analysis and several subgroup analyses based on follow-up duration, timing of injection, doses of cells, and imaging modalities were conducted to strengthen the statistic power of the study.
RESULTS
A total of 22 trials with 1360 patients were available for the current meta-analysis. The pooled statistics showed a significant improvement in LVEF {2.58 [95% confidence interval (CI), 1.32, 3.84]; p < 0.001}, LVEDV [−3.73, (95% CI, −6.94, −0.52), p=0.02], and LVESV [−4.67, (95% CI, −7.07, −2.28), p < 0.001] in the BMMC group, compared with the control group. However, in sensitivity analysis, a significant reduction in LVEDV disappeared, while the outcomes of LVEF and LVESV remained unchanged. The same results were presented in the subgroup analysis adjusting for imaging modalities and timing of cells injection.
CONCLUSION
BMMC transplantation in patients with STEMI was found to lead to improvement in LVEF, LVEDV, and LVESV parameters, indicating that cell therapy has a potential beneficial effect on LV remodeling and function.

Keyword

ST elevation myocardial infarction; stroke volume; bone marrow transplantation; left ventricular dysfunction

MeSH Terms

Bone Marrow Transplantation
Bone Marrow*
Cell- and Tissue-Based Therapy
Follow-Up Studies
Humans
Myocardial Infarction*
Percutaneous Coronary Intervention
Stroke Volume
Ventricular Dysfunction, Left

Figure

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  Fig. 1 Flow diagram of the literature search process and meta-analysis. BMMC, bone marrow mononuclear cell; G-CSF, granulocyte-colony stimulating factor; BMSC, bone mesenchymal cell.

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  Fig. 2 Forest plot of the difference in change left ventricular ejection fraction from baseline to follow-up. BMMC, bone marrow mononuclear cell; MD, mean difference; SD, standard deviation; CI, confidence interval.

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  Fig. 3 Forest plot of the difference in change left ventricular end-diastolic volume from baseline to follow-up. BMMC, bone marrow mononuclear cell; MD, mean difference; SD, standard deviation; CI, confidence interval.

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  Fig. 4 Forest plot of the difference in change left ventricular end-systolic volume from baseline to follow-up. BMMC, bone marrow mononuclear cell; MD, mean difference; SD, standard deviation; CI, confidence interval.

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  Fig. 5 Forest plot of change in left ventricular ejection fraction of BMMC transplantation at different time durations. BMMC, bone marrow mononuclear cell; MD, mean difference; SD, standard deviation; CI, confidence interval.

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  Fig. 6 Forest plot of change in left ventricular end-diastolic volume of BMMC transplantation at different time durations. BMMC, bone marrow mononuclear cell; MD, mean difference; SD, standard deviation; CI, confidence interval.

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  Fig. 7 Forest plot of change in left ventricular end-systolic volume of BMMC transplantation at different time durations. BMMC, bone marrow mononuclear cell; MD, mean difference; SD, standard deviation; CI, confidence interval.

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