Treatment of acute myocardial infarction with intracoronary administration of autologous bone marrow cells
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AbstractModern reperfusion strategies and medical treatment reduce myocardial necrosis and have improved prognosis after acute myocardial infarction. However, some patients still develop extensive myocardial infarctions and are at risk of congestive heart failure, and these patients have a poor prognosis. Accordingly, there is a need for new treatment options to regenerate the human heart.
In experimental models and in small clinical studies, administration of bone marrow cells have improved cardiac function, and some studies have indicated that bone marrow cells can generate new myocardium in a process called transdifferentiation.
In the larger ASTAMI study, 100 patients with acute myocardial infarction were randomized to intracoronary administration of their own bone marrow cells, or to a control group. All patients received best medical therapy, and were followed for 12 months. The primary aim was to investigate whether bone marrow cell therapy improved myocardial function compared with standard therapy only, as measured by nuclear imaging, echocardiograpy and magnetic resonance imaging.
There was a similar improvement in cardiac function in both groups. Results were consistent, since none of the imaging modalities revealed differences between groups for left ventricular ejection fraction, end-diastolic volume or infarct size. The treatment group improved exercise time significantly more than the control group. However, this was likely a placebo-effect, since there was a similar improvement in peak oxygen consumption. After 12 months, all patients were alive, and the number of adverse events were similar in the groups.
Lunde and colleagues conclude that with the methods used, intracoronary administration of autologous bone marrow cells in patients with acute myocardial infarction was safe, but did not improve cardiac funtion to a clinically significant degree.
LIST OF PAPERS
I Lunde K, Solheim S, Aakhus S, Arnesen H, Abdelnoor M, Forfang K. Autologous stem cell transplantation in acute myocardial infarction: The ASTAMI randomized controlled trial. Intracoronary transplantation of autologous mononuclear bone marrow cells, study design and safety aspects. Scandinavian Cardiovascular Journal 2005;39:150-158.
II Lunde K, Solheim S, Aakhus S, Arnesen H, Abdelnoor M, Egeland T, Endresen K, Ilebekk A, Mangschau A, Fjeld JG, Smith HJ, Taraldsrud E, Grøgaard HK, Bjørnerheim R, Brekke M, Müller C, Hopp E, Ragnarsson A, Brinchmann JE, Forfang K. Intracoronary injection of mononuclear bone marrow cells in acute myocardial infarction. New England Journal of Medicine 2006;355:1199-1209.
III Lunde K, Solheim S, Aakhus S, Arnesen H, Moum T, Abdelnoor M, Egeland T, Endresen K, Ilebekk A, Mangschau A, Forfang K. Exercise capacity and quality of life after intracoronary injection of autologous mononuclear bone marrow cells in acute myocardial infarction: Results from the autologous stem cell transplantation in acute myocardial infarction (ASTAMI) randomized controlled trial. American Heart Journal 2007;154:710.e1-710.e8.
IV Lunde K, Solheim S, Forfang K, Arnesen H, Brinch L, Bjørnerheim R, Ragnarsson A, Egeland T, Endresen K, Ilebekk A, Mangschau A, Aakhus S. Anterior myocardial infarction with acute percutaneous coronary intervention and intracoronary injection of autologous mononuclear bone marrow cells. Safety, clinical outcome, and serial changes in left ventricular function during 12 months follow-up. .Journal of the American College of Cardiology 2008;51:674-6