Lipinski Michael J, Biondi-Zoccai Giuseppe G L, Abbate Antonio, Khianey Reena, Sheiban Imad, Bartunek Jozef, Vanderheyden Marc, Kim Hyo-Soo, Kang Hyun-Jae, Strauer Bodo E, Vetrovec George W
Department of Internal Medicine, University of Virginia, Charlottesville, Virginia, USA.
J Am Coll Cardiol. 2007 Oct 30;50(18):1761-7. doi: 10.1016/j.jacc.2007.07.041. Epub 2007 Oct 15.
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.
我们旨在对急性心肌梗死（AMI）后冠状动脉内细胞治疗的临床试验进行荟萃分析。
冠状动脉内细胞治疗仍在AMI背景下进行评估，对左心室射血分数（LVEF）有不同影响。
我们在CENTRAL、mRCT和PubMed数据库中检索了关于近期AMI（≤14天）、经皮血管重建且随访≥3个月的患者进行冠状动脉内细胞治疗的对照试验。主要终点是LVEF的变化，次要终点是梗死面积、心脏大小和二分法临床结局的变化。
检索到10项研究（698例患者，中位随访6个月），采用随机效应进行汇总分析。接受冠状动脉内细胞治疗的受试者LVEF有显著改善（增加3.0%[95%置信区间（CI）1.9至4.1]；p<0.001），梗死面积减少（-5.6%[95%CI -8.7至-2.5]；p<0.001），收缩末期容积减少（-7.4 ml[95%CI -12.2至-2.7]；p = 0.002），舒张末期容积有减少趋势（-4.6 ml[95%CI -10.4至1.1]；p = 0.11）。冠状动脉内细胞治疗还与复发性AMI名义上显著减少（p = 0.04）以及死亡、因心力衰竭再次住院和重复血管重建减少趋势相关。荟萃回归表明注射细胞体积与LVEF变化之间存在剂量反应关联（p = 0.066）。
AMI经皮冠状动脉介入治疗后冠状动脉内细胞治疗似乎在心脏功能和重塑方面提供了统计学和临床相关益处。这些数据证实了这种新疗法的有益影响，并支持进一步开展多中心随机试验，以解决冠状动脉内细胞治疗对总体和无事件长期生存的影响。
