Fondazione Cardiocentro Ticino, Lugano, Switzerland.
Swiss Med Wkly. 2012 Jul 25;142:w13632. doi: 10.4414/smw.2012.13632. eCollection 2012.
Intracoronary injection of autologous bone marrow-derived mononucleated cells (BM-MNC) may improve LV function shortly after acute ST elevation myocardial infarction (STEMI), but little is known about the long-term durability of the treatment effect.
In a single-centre trial a total of 60 patients with acute anterior STEMI, successful reperfusion therapy and a left ventricular ejection fraction (LVEF) of <50% were screened for the study. 23 patients were actively treated with intracoronary infusion of BM-MNC within a median of 3 days. The open-label control group consisted of 19 patients who did not consent to undergo BM-MNC treatment but agreed to undergo regular clinical and echocardiographic follow-up for up to 5 years after AMI.
Whereas at 4 months there was no significant difference between the increase in LVEF in the BM-MNC group and the control group (+7.0%, 95%CI 3.6; 10.4) vs. +3.9%, 95%CI -2.1; 10), the absolute increase at 5 years remained stable in the BM-MNC but not in the control group (+7.95%, 95%CI 3.5; 12.4 vs. -0.5%, 95%CI -5.4; 4.4; p for interaction between groups = 0.035).
In this single-centre, open-labelled study, intracoronary administration of BM-MNC is feasible and safe in the short term. It is also associated with sustained improvement of left ventricular function in patients with acute myocardial infarction, encouraging phase III studies to examine the potential BM-MNC effect on clinical outcome.
急性 ST 段抬高型心肌梗死（STEMI）后，经冠状动脉内注射自体骨髓来源的单个核细胞（BM-MNC）可能会改善左心室功能，但对该治疗效果的长期耐久性知之甚少。
在一项单中心试验中，共筛选了 60 例急性前壁 STEMI 患者，这些患者接受了成功的再灌注治疗，且左心室射血分数（LVEF）<50%。23 例患者在中位数 3 天内接受了经冠状动脉内输注 BM-MNC 的积极治疗。开放标签对照组由 19 例患者组成，这些患者不同意接受 BM-MNC 治疗，但同意在急性心肌梗死后进行长达 5 年的常规临床和超声心动图随访。
在 4 个月时，BM-MNC 组和对照组的 LVEF 增加没有显著差异（+7.0%，95%CI 3.6; 10.4）与+3.9%，95%CI-2.1; 10），但在 5 年时，BM-MNC 组的绝对增加保持稳定，而对照组则没有（+7.95%，95%CI 3.5; 12.4 与-0.5%，95%CI-5.4; 4.4；组间交互作用的 p 值=0.035）。
在这项单中心、开放标签研究中，经冠状动脉内给予 BM-MNC 在短期内是可行且安全的。它还与急性心肌梗死患者左心室功能的持续改善相关，这鼓励进行 III 期研究，以检查 BM-MNC 对临床结局的潜在影响。
