Shah Rahman, Latham Samuel B, Khan Sajjad A, Shahreyar Muhammad, Hwang Inyong, Jovin Ion S
Department of Internal Medicine, University of Tennessee, Memphis, Tennessee.
Department of Internal Medicine, Aga Khan University, Karachi, Pakistan.
Clin Cardiol. 2018 Apr;41(4):525-531. doi: 10.1002/clc.22922. Epub 2018 Apr 17.
A substantial proportion of patients with coronary artery disease do not achieve complete revascularization and continue to experience refractory angina despite optimal medical therapy. Recently, stem cell therapy has emerged as a potential therapeutic option for these patients. However, findings of individual trials have been scrutinized because of their small sample sizes and lack of statistical power. Therefore, we conducted an updated comprehensive meta-analysis of available randomized controlled trials (RCTs) with the largest sample size ever reported on this subject.
In patients with chronic angina stem cell therapy improves clinical outcomes.
Scientific databases and websites were searched for RCTs. Data were independently collected by 2 investigators, and disagreements were resolved by consensus. Data from 10 trials including 658 patients were analyzed.
Stem cell therapy improved Canadian Cardiovascular Society angina class (risk ratio: 1.53, 95% CI: 1.09 to 2.15, P = 0.013), exercise capacity (standardized mean difference [SMD]: 0.56, 95% CI: 0.23 to 0.88, P = 0.001), and left ventricular ejection fraction (SMD: 0.63, 95% CI: 0.27 to 1.00, P = 0.001) compared with placebo. It also decreased anginal episodes (SMD: -1.21, 95% CI: -2.40 to -0.02, P = 0.045) and myocardial perfusion defects (SMD: -0.70, 95% CI: -1.11 to -0.29, P = 0.001). However, no improvements in all-cause mortality were observed after a relatively short follow-up.
In patients with chronic angina on optimal medical therapy, stem cell therapy improves symptoms, exercise capacity, and left ventricular ejection fraction. These findings warrant confirmation using larger trials.
相当一部分冠心病患者未能实现完全血运重建，尽管接受了最佳药物治疗，但仍持续经历难治性心绞痛。近年来，干细胞治疗已成为这些患者潜在的治疗选择。然而，由于个体试验样本量小且缺乏统计学效力，其研究结果受到了严格审查。因此，我们对现有随机对照试验（RCT）进行了更新的综合荟萃分析，该分析样本量为本主题报道过的最大样本量。
在慢性心绞痛患者中，干细胞治疗可改善临床结局。
检索科学数据库和网站以获取RCT。数据由两名研究者独立收集，分歧通过协商解决。对包括658例患者的10项试验数据进行分析。
与安慰剂相比，干细胞治疗改善了加拿大心血管学会心绞痛分级（风险比：1.53，95%可信区间：1.09至2.15，P = 0.013）、运动能力（标准化均数差[SMD]：0.56，95%可信区间：0.23至0.88，P = 0.001）和左心室射血分数（SMD：0.63，95%可信区间：0.27至1.00，P = 0.001）。它还减少了心绞痛发作次数（SMD：-1.21，95%可信区间：-2.40至-0.02，P = 0.045）和心肌灌注缺损（SMD：-0.70，95%可信区间：-1.11至-0.29，P = 0.001）。然而，在相对较短的随访期后，未观察到全因死亡率的改善。
在接受最佳药物治疗的慢性心绞痛患者中，干细胞治疗可改善症状、运动能力和左心室射血分数。这些发现需要通过更大规模的试验予以证实。
