We aimed to perform a meta-analysis of clinical trials on intracoronary cell therapy
after acute myocardial infarction (AMI).
Intracoronary cell therapy continues to be evaluated in the setting of AMI with variable
impact on left ventricular ejection fraction (LVEF).
We searched the CENTRAL, mRCT, and PubMed databases for controlled trials reporting
on intracoronary cell therapy performed in patients with a recent AMI (< or =14 days),
revascularized percutaneously, with follow-up of > or =3 months. The primary end point
was change in LVEF, and secondary end points were changes in infarct size, cardiac
dimensions, and dichotomous clinical outcomes.
Ten studies were retrieved (698 patients, median follow-up 6 months), and pooling
was performed with random effect. Subjects that received intracoronary cell therapy
had a significant improvement in LVEF (3.0% increase [95% confidence interval (CI)
1.9 to 4.1]; p < 0.001), as well as a reduction in infarct size (-5.6% [95% CI -8.7
to -2.5]; p < 0.001) and end-systolic volume (-7.4 ml [95% CI -12.2 to -2.7]; p =
0.002), and a trend toward reduced end-diastolic volume (-4.6 ml [95% CI -10.4 to
1.1]; p = 0.11). Intracoronary cell therapy was also associated with a nominally significant
reduction in recurrent AMI (p = 0.04) and with trends toward reduced death, rehospitalization
for heart failure, and repeat revascularization. Meta-regression suggested the existence
of a dose-response association between injected cell volume and LVEF change (p = 0.066).
Intracoronary cell therapy following percutaneous coronary intervention for AMI appears
to provide statistically and clinically relevant benefits on cardiac function and
remodeling. These data confirm the beneficial impact of this novel therapy and support
further multicenter randomized trials targeted to address the impact of intracoronary
cell therapy on overall and event-free long-term survival.