Sammendrag
Background: Recently, experimental studies have shown improvement on left ventricular function and reduction in infarct scar size after intracoronary injection of autologous cells derived from bone marrow (BMC) in the acute fase of myocardial infarction. There is yet no large clinical trials released about the subject, but five intermediate sized randomized trials have been published.
Method: I have reviewed the five studies BOOST, Janssens et al, ASTAMI, REPAIR-AMI and REGENT, translated and somewhat summarized them before I have discussed the most important and relevant results. To supply my findings, I have included the most relevant results from the two meta- analysis by Abdel-Latif et al. and Martin-Rendon et al.
Results: To this date, it may seem that BMC treatment gives a small to moderate improvement in left ventricular parameters as well as a reduction in infarct scar size. The results are somewhat heterogenous, but overall they seem to point in a positive direction. In the meta-analyses, BMC therapy is found to significantly improve left ventricular ejection fraction with 3,0 – 3,6 % points.
Some of the studies suggest that better results can be expected on patients with severly depressed left ventricular function, as well as when cells are injected five or more days after the PCI treatment.
Conclusion: Stem cell treatment for acute myocardial infarction is a promising, new treatment option. The data from the trials assessed suggest that one can achieve improvement on top of conventional therapy, if yet only moderate. Further, adequately powered trials using optimal dosing and timing, longer term outcome assessments, more reliable and more patient-centered outcomes are required before this treatment can be considered for routine clinical use.