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Intra-coronary bone marrow mononuclear cell transplantation in patients with ST-elevation myocardial infarction: a
Suphot Srimahachota1, Smonporn Boonyaratavej, Pairoj Rerkpattanapipat
1Division of Cardiology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand. s_srimahachota@yahoo.co.th
Insights
Intra-coronary bone marrow mononuclear cell (BMC) transplantation is a safe procedure for ST-elevation myocardial infarction (STEMI) patients. However, this study found no significant improvement in left ventricular ejection fraction (LVEF) after six months.
Area of Science:
- Cardiology
- Regenerative Medicine
- Stem Cell Therapy
Background:
- Stem cell transplantation is explored for improving left ventricular ejection fraction (LVEF) post-ST-elevation myocardial infarction (STEMI).
- Outcomes of stem cell therapy for STEMI remain controversial, necessitating further investigation.
Purpose of the Study:
- To evaluate the impact of intra-coronary bone marrow mononuclear cell (BMC) transplantation on 6-month LVEF in STEMI patients.
- To compare LVEF changes in STEMI patients receiving BMC transplantation versus a control group.
Main Methods:
- STEMI patients with LVEF < 50% post-percutaneous coronary intervention (PCI) were randomized to intra-coronary BMC transplantation or control.
- BMC suspension was infused into the infarct area via PCI, with balloon occlusion during infusion.
- Cardiac magnetic resonance imaging assessed LVEF, scar volume, and LV volume at baseline and 6-month follow-up.
Main Results:
- A total of 23 patients (11 BMC, 12 control) were enrolled; mean BMC count was 420 x 10^6 cells with 96% viability.
- Both groups showed significant improvement in New York Heart Association function class at 6 months, with no inter-group difference.
- No significant improvements in scar volume, wall motion score index, or LVEF were observed in either group at 6 months.
Conclusions:
- Intra-coronary BMC transplantation in STEMI patients is feasible and safe at KCMH.
- The study did not demonstrate a significant improvement in LVEF at 6 months post-BMC transplantation.
Background:
Stem cell transplantation is a potential treatment to improve left ventricular ejection fraction (LVEF) after ST elevation myocardial infarction (STEMI). However, the outcomes still are controversial.
Objective:
To determine the 6-month LVEF of the patients who underwent intra-coronary bone marrow mononuclear cell (BMC) transplantation in patients with STEMI compared with controlled subjects.
Material And Method:
After successful percutaneous coronary intervention (PCI) in STEMI patients who had LVEF was less than 50% were randomized to intra-coronary BMC transplantation or control. Bone marrow aspiration of 100 cc was performed in the morning. After cellprocessing for three hours, the suspension of BMC about 10 cc were infused to infracted area using standard PCI technique. Balloon occlusion for three minutes was performed during cell infusion. Cardiac magnetic resonance imaging was used to determine LVEF scar volume and LV volume before and six-month follow-up.
Results:
Between September 2006 and July 2008, 23patients (11 in BMC group and 12 in control group) were enrolled. Mean BMC count before transplant was 420 x 10(6) cell with 96% viability. At six-month follow-up, New York Heart Association function class significantly improved in both groups (2.3 +/- 0.6 to 1.2 +/- 0. 4 for BMC and 2.3 +/- 0.7 to 1.3 +/- 0.5 for control group) but no difference was seen between groups. However, scar volume, wall motion score index, and LVEF did not show improvement after six months in both groups (33.7 +/- 7.7 to 33.5 +/- 7.6 for BMC and 31.1 +/- 7.1 to 32.6 +/- 8.3 for control group). No complication was observed during the procedure.
Conclusion:
BMC transplantation intra-coronary in patients with STEMI in KCMH was feasible and safe but LVEF improvement could not be demonstrated.
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