European Heart Journal Advance Access published online on June 3, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn220
Autologous bone marrow stem cells to treat acute myocardial infarction: a systematic review
1 Stem Cell Research Laboratory, NHS-Blood and Transplant, John Radcliffe Hospital, Headington, Oxford OX3 9BQ, UK
2 Nuffield Department of Clinical Laboratory Sciences, University of Oxford, Oxford, UK
3 Systematic Reviews Initiative, Clinical Research Group, NHSBT-Oxford, John Radcliffe Hospital, Oxford, UK
4 Department of Clinical Pharmacology, William Harvey Research Institute, Charterhouse Square, London, UK
Received 19 December 2007; revised 23 April 2008; accepted 6 May 2008.
* Corresponding author. Tel: +44 1865 447 934, Fax: +44 1865 447 931, Email: enca.martin-rendon{at}nbs.nhs.uk;enca.rendon{at}ndcsl.ox.ac.uk
Aims: To provide systematic assessment of the safety and efficacy of autologous bone marrow-derived stem cell (BMSC) transplantation in acute myocardial infarction (AMI) based on clinical evidence.
Methods and results: The search strategy included MEDLINE, EMBASE, the Cochrane Library, and Current Controlled Trials Register through to August 2007 for randomized controlled trials of BMSC treatment for AMI. Thirteen trials (14 comparisons) with a total of 811 participants were included. Data were analysed using a random effects model. Overall, stem cell therapy improved left ventricular ejection fraction (LVEF) by 2.99% [95% confidence interval (CI), 1.26–4.72%, P = 0.0007], significantly reduced left ventricular end-systolic volume (LVESV) by 4.74 mL (95% CI, –7.84 to –1.64 mL, P = 0.003), and myocardial lesion area by 3.51% (95% CI, –5.91 to –1.11%, P = 0.004) compared with controls. Subgroup analysis revealed that there was statistical significant difference in LEVF in favour of BMSCs when cells were infused within 7 days following AMI and when the BMSC dose administered was higher than 108 BMSCs. In addition, there were trends in favour of benefit for most clinical outcomes examined, although it should be acknowledged that the 95%CI included no significant difference.
Conclusion: Stem cell treatment for AMI still holds promise. Clinically, these data suggest that improvement over conventional therapy can be achieved. Further, adequately powered trials using optimal dosing, longer term outcome assessments, more reliable, and more patient-centred outcomes are required.
Key Words: Stem cells • Myocardial infarction • Bone marrow • Systematic review • Randomized clinical trials
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