| مستخلص: |
BACKGROUND Studies have demonstrated that administration of bone-marrow-derived progenitor cells (BMCs) into the coronary circulation of patients with acute myocardial infarction (AMI) is associated with functional cardiac repair. OBJECTIVE To investigate whether intracoronary infusion of BMCs improves vasodilatory function and blood flow in the infarct-related arteries of patients with reperfused AMI. DESIGN AND INTERVENTION This was a small substudy of the randomized, double-blind, multicenter REPAiR-AMI trial, which investigated the effects of intracoronary BMC transplantation on infarct remodeling in patients with ST-segment elevation AMI. This substudy was conducted in Germany at the University of Leipzig, Leipzig, the Johann Wolfgang Goethe University, Frankfurt, and the Heart and Diabetes Centre North Rhine- Westphalia, Bad Oeynhausen. The inclusion and exclusion criteria of the primary study have been described previously. All patients had undergone successful percutaneous coronary intervention and stent implantation during the acute phase of myocardial infarction, and harvesting of mononuclear cells from the bone marrow aspirate at 3-7 days after infarction. The baseline coronary vasodilator capacities of the infarct-related artery and a reference vessel were then measured with a 12 MHz pulsed Doppler ultrasound velocimeter. Subsequently, according to randomization, autologous mononuclear BMCs or placebo (cell-free medium and autologous serum) were administered into the lumen of the previously implanted stent. Doppler measurements were repeated at 4 months' follow-up. OUTCOME MEASURE The primary outcome measure was recovery of vasomotor function in the infarct-related artery, as assessed by coronary flow reserve (CFR). RESULTS This substudy initially recruited 58 individuals from the REPAIR-AMI patient population (30 BMC, 28 placebo). Five patients (three from the BMC group and two from the placebo group) were excluded from the final, substudy analysis because paired Doppler measurements (baseline and 4-month follow-up) were not available. The majority of patients were male and the mean age was 53 years. There were no significant differences in baseline demographic or clinical characteristics between the two treatment groups. Baseline CFR was lower in the infarctrelated artery when compared with the reference vessel in all patients (BMC: 2.0+0.1 vs 2.9±0.2, P<0.05; placebo: 1.9±0.1 vs 2.8±0.2, P<0.05). At 4-month follow-up, there was a highly significant, 90% improvement in CFR from baseline in the infarct-related arteries of patients treated with BMCs (from 2.04-0.1 to 3.8+0.2; P<0.001 for comparison with baseline and P=0.004 for comparison with the placebo group). At the end of the study, there was no longer a significant difference between the CFRs in the infarctrelated artery and the reference vessel in patients who received BMCs. By contrast, there was only a 47% increase in CFR in the placebo group at 4 months' follow-up (from 1.9±0.1 to 2.8±0.2). CONCLUSION Intracoronary infusion of BMCs is associated with a normalization of CFR in the infarct-related vessel in patients with reperfused AMI. [ABSTRACT FROM AUTHOR] |
