Soetisna Tri Wisesa, Thamrin Ahmad Muslim Hidayat, Permadijana Diajeng, Ramadhani Andi Nurul Erisya, Santoso Anwar, Mansyur Muchtaruddin
Adult Cardiac Surgery Division, Department of Thoracic and Cardiovascular Surgery, Harapan Kita National Cardiovascular Center Hospital, Jakarta 11420, Indonesia.
Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, University of Indonesia, Jakarta 10430, Indonesia.
J Clin Med. 2023 Jun 30;12(13):4430. doi: 10.3390/jcm12134430.
IMSC transplantation during CABG is considered one of the most promising methods to effectively deliver stem cells and has been widely studied in many trials. But the results of outcomes and safety of this modality still vary widely. We conducted this meta-analysis of randomized controlled trials (RCTs) to evaluate not only the outcome but also the safety of this promising method. A meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A comprehensive literature search was undertaken using the PubMed, Scopus, and Cochrane databases. Articles were thoroughly evaluated and analyzed. Twenty publications about IMSC during CABG were included. Primary outcomes were measured using LVEF, LVESV, LVESVI, LVESD, LVEDV, LVEDVI, LVEDD, WMSI, and 6-MWT. Safety measures were depicted by total deaths, MACE, CRD, CVA, myocardial infarction, ventricular arrhythmia, and cardiac-related readmission. IMSC transplantation during CABG significantly improved LVEF (MD = 3.89%; 95% CI = 1.31% to 6.46%; = 0.003) and WMSI (MD = 0.28; 95% CI = 0.01-0.56; = 0.04). Most of the other outcomes showed favorable results for the IMSC group but were not statistically significant. The safety analysis also showed no significant risk difference for IMSC transplantation compared to CABG alone. IMSC during CABG can safely improve cardiac function and tend to improve cardiac volumes and dimensions. The analysis and application of influencing factors that increase patients' responses to IMSC transplantation are important to achieve long-term improvement.
冠状动脉旁路移植术（CABG）期间进行缺血心肌干细胞（IMSC）移植被认为是有效递送干细胞最有前景的方法之一，并且已经在许多试验中得到广泛研究。但这种方式的疗效和安全性结果仍差异很大。我们进行这项随机对照试验（RCT）的荟萃分析，不仅是为了评估这种有前景方法的疗效，也是为了评估其安全性。根据系统评价和荟萃分析的首选报告项目（PRISMA）指南进行荟萃分析。使用PubMed、Scopus和Cochrane数据库进行全面的文献检索。对文章进行了全面评估和分析。纳入了20篇关于CABG期间IMSC的出版物。主要结局指标采用左心室射血分数（LVEF）、左心室收缩末期容积（LVESV）、左心室收缩末期容积指数（LVESVI）、左心室收缩末期内径（LVESD）、左心室舒张末期容积（LVEDV）、左心室舒张末期容积指数（LVEDVI）、左心室舒张末期内径（LVEDD）、心肌重量指数（WMSI）和6分钟步行试验（6-MWT）来衡量。安全性指标通过总死亡人数、主要不良心血管事件（MACE）、脑血管意外（CRD）、脑血管意外（CVA）、心肌梗死、室性心律失常和心脏相关再入院来描述。CABG期间IMSC移植显著改善了LVEF（MD = 3.89%；95%CI = 1.31%至6.46%；P = 0.003）和WMSI（MD = 0.28；95%CI = 0.01 - 0.56；P = 0.04）。大多数其他结局指标在IMSC组显示出较好的结果，但无统计学意义。安全性分析还显示，与单纯CABG相比，IMSC移植没有显著的风险差异。CABG期间的IMSC可以安全地改善心脏功能，并倾向于改善心脏容积和尺寸。分析和应用增加患者对IMSC移植反应的影响因素对于实现长期改善很重要。
