Hosseinpour Alireza, Hosseinpour Hamidreza, Attar Armin
Department of Cardiovascular Medicine, School of Medicine, Shiraz University of Medical Sciences, Zand Street, Shiraz, Iran.
Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Cardiovasc Drugs Ther. 2023 Dec;37(6):1143-1153. doi: 10.1007/s10557-022-07359-3. Epub 2022 Jul 25.
Heart failure (HF) is a major complication of acute myocardial infarction (AMI). Transplantation of bone marrow mononuclear cells (BM-MNC) in the setting of AMI has been proposed as a means for myocardial tissue regeneration. Several trials have explored the outcomes of these cells on surrogate end points such as left ventricular ejection fraction (LVEF) in patients with AMI. However, the data regarding the clinical efficacy are infrequent. Here, we performed a meta-analysis investigating the effect of BM-MNCs injection on the rate of hospitalization for HF in the long-term follow-up period.
PubMed, Scopus, and Cochrane databases were queried with various combinations of keywords through May 2, 2022. A random-effects meta-analysis was performed to calculate risk ratio (RR) and 95% confidence interval (CI) of hospitalization for HF, all-cause mortality, and stroke rate. Subgroup analyses for hospitalization based on time and cell dose were performed.
A total of 2150 patients with AMI across 22 trials were included for quantitative synthesis. At long-term follow-up, AMI patients treated with an intracoronary injection of BM-MNCs were less likely to be hospitalized for heart failure compared to the control group receiving standard treatment (RR = 0.54, 95% CI = [0.37; 0.78], p = 0.002). There was no association between BM-MNC therapy and all-cause mortality (RR = 0.69, 95% CI = [0.47; 1.01], p = 0.05) and stroke (RR = 1.12, 95% CI= [0.24; 5.21], p = 0.85).
Autologous injection of BM-MNC in the setting of AMI may be associated with decreased risk of hospitalization of heart failure in the long term. However, its effect on all-cause mortality and stroke rate is questionable.
心力衰竭（HF）是急性心肌梗死（AMI）的主要并发症。在AMI患者中进行骨髓单个核细胞（BM-MNC）移植已被提议作为心肌组织再生的一种方法。多项试验探讨了这些细胞对AMI患者左心室射血分数（LVEF）等替代终点的影响。然而，关于临床疗效的数据并不常见。在此，我们进行了一项荟萃分析，以研究BM-MNC注射在长期随访期对HF住院率的影响。
通过各种关键词组合查询截至2022年5月2日的PubMed、Scopus和Cochrane数据库。进行随机效应荟萃分析，以计算HF住院率、全因死亡率和卒中率的风险比（RR）和95%置信区间（CI）。基于时间和细胞剂量对住院情况进行亚组分析。
共有来自22项试验的2150例AMI患者纳入定量合成分析。在长期随访中，与接受标准治疗的对照组相比，接受冠状动脉内注射BM-MNC治疗的AMI患者因心力衰竭住院的可能性较小（RR = 0.54，95%CI = [0.37; 0.78]，p = 0.002）。BM-MNC治疗与全因死亡率（RR = 0.69，95%CI = [0.47; 1.01]，p = 0.05）和卒中（RR = 1.12，95%CI = [0.24; 5.21]，p = 0.85）之间无关联。
在AMI患者中自体注射BM-MNC可能与长期心力衰竭住院风险降低有关。然而，其对全因死亡率和卒中率的影响尚不确定。
