P5587Long-term effects of autologous bone marrow CD133+ cell transplantation on myocardial structure and function after acute myocardial infarction

Abstract

Aim: The aim of the study was to test the hypothesis that autologous bone marrow CD 133+ cell transplantation in patients with primary ST-elevation myocardial infarction (STEMI) improves structure and functional performance of the heart in the long-term. Materials and methods: A total of 26 patients (pts) with primary STEMI were admitted to Coronary Care Unit of Cardiology Research Institute from 2006 to 2007. Patients were randomized to two groups: group 1 comprised pts who underwent PCI and autologous bone marrow CD 133+ cell transplantation at day 16±6 after STEMI (n=10); group 2 comprised pts with only PCI at day 11±10 after STEMI (n=16). A follow-up study was performed 7.70±0.42 years after STEMI and consisted of physical examination, exercise tolerance assessment by 6-min walk test (6MWT), and echocardiography exam (VIVID 7, GE). Results: Vital status information was obtained in 23 pts (88%) including 8 patients from group 1 and 15 pts from group 2. During a median follow-up period of 7.70±0.42 years, 9 patients (22%) died. The measurement of left ventricular (LV) ejection fraction (EF) was the primary endpoint. Analysis of mean changes from baseline in LV EF did not show significant differences between groups: 46.8±9.0% vs. 39.1±9.8%, p=0.17. Seven-year follow up showed that mean changes from baseline in LV volumetric parameters of the heart were lower in group 1: LV enddiastolic volume (EDV) was 100.7±50.2 mL vs. 144.4±42.7 mL (p=0.049); LV endsystolic volume (ESV) was 56.3±37.8 mL versus 89.7±38.7 mL (p=0.049). Death, repeated myocardial infarction (RMI), unstable angina, chronic heart failure (CHF) NYHA class > II, and stroke were secondary endpoints. Safety endpoints of autologous bone marrow CD 133+ cell transplantation were clinically significant cardiac arrhythmias and newly diagnosed oncology diseases. Total incidence of deaths in group 1 was lower compared with that in group 2: 2 pts (20%) vs. 7 pts (44%), respectively (p=0.11). Cardiovascular deaths occurred in 2 cases (20%) in group 1 vs. 4 cases (25%) in group 2 (p=0.53). Non-cardiovascular deaths occurred in 2 cases in group 2 (12%). Cause of death of 1 patient (6%) from group 2 was unknown. Incidence rates of stroke did not significantly differ between groups. CHF class II and more was found more often in group 2: 2 cases (20%) in group 1 vs. 8 cases (50%) in group 2 (p=0.06). In group 2, 8 cases (50%) of RMI with 4 fatal outcomes were recorded. No RMI cases were registered in group 1. Unstable angina was more frequent in group 2 over the entire period of the follow-up: 11 pts (69%) in group 2 versus 2 pts (20%) in group 1 (p=0.04). Conclusion: According to our long-term follow up study, autologous bone marrow CD133+ cell transplantation represented a safe procedure that contributed to improved course of coronary artery disease and prevented the development of LV dilatation though without an effect on systolic function of the LV.