Intracoronary Bone Marrow–Derived Progenitor Cells in Acute Myocardial Infarction
Volker Schächinger, M.D., Sandra Erbs, M.D., Albrecht Elsässer, M.D., Werner Haberbosch, M.D., Rainer Hambrecht, M.D., Hans Hölschermann, M.D., Jiangtao Yu, M.D., Roberto Corti, M.D., Detlef G. Mathey, M.D., Christian W. Hamm, M.D., Tim Süselbeck, M.D., Birgit Assmus, M.D., Torsten Tonn, M.D., Stefanie Dimmeler, Ph.D., Andreas M. Zeiher, M.D., for the REPAIR-AMI Investigators
Background Pilot trials suggest that the intracoronary administrationof autologous progenitor cells may improve left ventricularfunction after acute myocardial infarction.
Methods In a multicenter trial, we randomly assigned 204 patientswith acute myocardial infarction to receive an intracoronaryinfusion of progenitor cells derived from bone marrow (BMC)or placebo medium into the infarct artery 3 to 7 days aftersuccessful reperfusion therapy.
Results At 4 months, the absolute improvement in the globalleft ventricular ejection fraction (LVEF) was significantlygreater in the BMC group than in the placebo group (mean [±SD]increase, 5.5±7.3% vs. 3.0±6.5%; P=0.01). Patientswith a baseline LVEF at or below the median value of 48.9% derivedthe most benefit (absolute improvement in LVEF, 5.0%; 95% confidenceinterval, 2.0 to 8.1). At 1 year, intracoronary infusion ofBMC was associated with a reduction in the prespecified combinedclinical end point of death, recurrence of myocardial infarction,and any revascularization procedure (P=0.01).
Conclusions Intracoronary administration of BMC is associatedwith improved recovery of left ventricular contractile functionin patients with acute myocardial infarction. Large-scale studiesare warranted to examine the potential effects of progenitor-celladministration on morbidity and mortality. (ClinicalTrials.govnumber, NCT00279175
[ClinicalTrials.gov]
.)
Source Information
From the Department of Internal Medicine III, Johann Wolfgang Goethe University, Frankfurt (V.S., B.A., S.D., A.M.Z.); the Department of Cardiology, Herzzentrum Leipzig, Leipzig (S.E., R.H.); the Department of Cardiology, Kerckhoff Klinik, Bad Nauheim (A.E., C.W.H.); the Department of Internal Medicine, Zentralklinikum Suhl, Suhl (W.H.); the Department of Cardiology, Universitätsklinikum Giessen, Giessen (H.H.); the Department of Cardiology, Zentralklinikum, Bad Berka (J.Y.); the Hamburg University Cardiovascular Center, Hamburg (D.G.M.); the Department of Cardiology, Universitätsklinikum, Mannheim (T.S.); and the Institute for Transfusion Medicine and Immunohematology, Red Cross Blood Donor Service Baden–Württemberg–Hessen, Frankfurt (T.T.) — all in Germany; and the Department of Cardiology, Universitätsspital, Zurich, Switzerland (R.C.).
Address reprint requests to Dr. Zeiher at the Department of Internal Medicine III, J.W. Goethe University, Theodor-Stern-Kai 7, D-60590 Frankfurt, Germany, or at zeiher{at}em.uni-frankfurt.de.
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