European Heart Journal Advance Access published online on September 22, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp374
Intracoronary bone marrow cell transfer after myocardial infarction: 5-year follow-up from the randomized-controlled BOOST trial
1 Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
2 Department of Diagnostic Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
3 Department of Biometrics, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
4 Department of Hematology, Hemostaseology, Oncology, and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
Received 15 October 2008; revised 19 July 2009; accepted 20 August 2009 * Corresponding author. Tel: +49 511 532 3878, Fax: +49 511 532 3357, Email: meyer.gerdp{at}mh-hannover.de
Aims: We assessed whether a single intracoronary infusion of autologous bone marrow cells (BMCs) can have a sustained impact on left ventricular ejection fraction (LVEF) in patients after ST-elevation myocardial infarction (STEMI). In the BOne marrOw transfer to enhance ST-elevation infarct regeneration (BOOST) trial, 60 patients with STEMI and successful percutaneous coronary intervention were randomized to a control and a cell therapy group. As previously reported, BMC transfer led to an improvement of LVEF by 6.0% at 6 months (P = 0.003) and 2.8% at 18 months (P = 0.27).
Methods and results: Left ventricular ejection fraction and clinical status were re-assessed in all surviving patients after 61 ± 11 months. Major adverse cardiac events occurred with similar frequency in both groups. When compared with baseline, LVEF assessed by magnetic resonance imaging at 61 months decreased by 3.3 ± 9.5% in the control group and by 2.5 ± 11.9% in the BMC group (P = 0.30). Patients with an infarct transmurality > median appeared to benefit from BMC transfer throughout the 61-month study period (P = 0.040).
Conclusion: A single intracoronary application of BMCs does not promote a sustained improvement of LVEF in STEMI patients with relatively preserved systolic function. It is conceivable that a subgroup of patients with more transmural infarcts may derive a sustained benefit from BMC therapy. However, this needs to be tested prospectively in a randomized trial.
Key Words: Acute myocardial infarction • Cell therapy • Magnetic resonance imaging
These authors contributed equally to this work.