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Updated: Jul 21, 2026
Embryonic Stem Cell-Derived Endothelial Cells for Treatment of Hindlimb Ischemia
Published on: January 23, 2009
Microvascular obstruction identifies a subgroup of patients who benefit from stem cell therapy following ST-elevation
Sarah J Davidson1, Jerome Roncalli2, Daniel Surder3
1Duke University School of Medicine, Durham, NC.
Background:
Microvascular obstruction (MVO) is associated with greater infarct size, adverse left-ventricular (LV) remodeling and reduced ejection fraction following ST-elevation myocardial infarction (STEMI). We hypothesized that patients with MVO may constitute a subgroup of patients that would benefit from intracoronary stem cell delivery with bone marrow mononuclear cells (BMCs) given previous findings that BMCs tended to improve LV function only in patients with significant LV dysfunction.
Methods And Results:
We analyzed the cardiac MRIs of 356 patients (303 M, 53 F) with anterior STEMIs who received autologous BMCs or placebo / control as part of 4 randomized clinical trials that included the Cardiovascular Cell Therapy Research Network (CCTRN) TIME trial and its pilot, the multicenter French BONAMI trial and SWISS-AMI trials. A total of 327 patients had paired imaging data at 1 year. All patients received 100 to 150 million intracoronary autologous BMCs or placebo / control 3 to 7 days following primary PCI and stenting. LV function, volumes, infarct size and MVO were assessed prior to infusion of BMCs and 1 year later. Patients with MVO (n = 210) had reduced LVEF and much greater infarct size and LV volumes compared to patients without MVO (n = 146) (P < .01). At 12 months, patients with MVO who received BMCs had significantly greater recovery of LVEF compared to those patients with MVO who received placebo (absolute difference = 2.7%; P < .05). Similarly, left-ventricular end-diastolic (LVEDVI) and end-systolic volume indices (LVESVI) demonstrated significantly less adverse remodeling in patients with MVO who received BMCs compared to placebo. In contrast, no improvement in LVEF or LV volumes was observed in those patients without MVO who received BMCs compared to placebo.
Conclusions:
The presence of MVO on cardiac MRI following STEMI identifies a subgroup of patients who benefit from intracoronary stem cell therapy.
Insights
Microvascular obstruction (MVO) after ST-elevation myocardial infarction (STEMI) identifies patients who benefit from bone marrow mononuclear cell (BMC) therapy. BMCs improved left-ventricular function and reduced adverse remodeling in MVO patients, but not in those without MVO.
Area of Science:
- Cardiology
- Regenerative Medicine
- Medical Imaging
Background:
- Microvascular obstruction (MVO) is linked to larger infarcts, adverse left-ventricular (LV) remodeling, and reduced ejection fraction post-ST-elevation myocardial infarction (STEMI).
- Previous research suggests bone marrow mononuclear cells (BMCs) may improve LV function primarily in patients with significant LV dysfunction.
Purpose of the Study:
- To investigate whether patients with MVO following STEMI represent a subgroup that benefits from intracoronary BMC delivery.
- To evaluate the efficacy of BMC therapy in patients with and without MVO.
Main Methods:
- Analysis of cardiac MRI data from 356 patients with anterior STEMIs across 4 randomized clinical trials.
- Patients received intracoronary autologous BMCs or placebo 3-7 days post-primary PCI and stenting.
- Assessment of LV function, volumes, infarct size, and MVO at baseline and 1 year post-intervention.
Main Results:
- Patients with MVO (n=210) exhibited reduced LVEF, larger infarct size, and greater LV volumes compared to those without MVO (n=146).
- At 12 months, MVO patients receiving BMCs showed significantly improved LVEF recovery (2.7% absolute difference) versus placebo.
- BMC therapy led to less adverse LV remodeling (reduced LVEDVI and LVESVI) in MVO patients compared to placebo, with no observed benefits in patients without MVO.
Conclusions:
- Cardiac MRI detection of MVO in STEMI patients identifies a specific subgroup that benefits from intracoronary stem cell therapy.
- Intracoronary BMC administration improves LV function and reduces adverse remodeling in STEMI patients with MVO.
