Timing for intracoronary administration of bone marrow mononuclear cells after acute ST-elevation myocardial infarction: a pilot study

Rongchong Huang, Kang Yao, Aijun Sun, Juying Qian, Lei Ge, Yiqi Zhang, Yuhong Niu, Keqiang Wang, Yunzeng Zou, Junbo Ge

Most studies on intracoronary bone marrow mononuclear cell (BMC) transplantation for acute myocardial infarction (AMI) involve treatment 3-7 days after primary percutaneous coronary intervention (PCI); however, the optimal timing is unknown. The present study assessed the therapeutic effect at different times after ST-elevation myocardial infarction (STEMI). The present trial was not blinded. A total of 104 patients with a first STEMI and a left ventricular ejection fraction (LVEF) below 50%, who had PCI of the infarct-related artery, were randomly assigned to receive intracoronary infusion of BMC within 24 hours (Group A, n = 27), 3 to 7 days after PCI (Group B, n = 26), or 7 to 30 days after PCI (Group C, n = 26), or to the control group (CON, n = 25), which received saline infusion performed immediately after emergency PCI. All patients in Group A, B and C received an injection of 15 ml of cell suspension containing approximately 4.9 × 10(8) BMC into the infarct-related artery after successful PCI. Compared to CON and group C patients, Group A and B patients had a significantly higher absolute increase in left ventricular ejection fraction (LVEF) from baseline to 12 months (the change of LVEF: 3.4% ± 5.7% in CON, 7.9% ± 4.9% in Group A, 6.9% ± 3.9% in Group B, 4.7% ± 3.7% in Group C), a greater decrease in left ventricular end-systolic volumes (LVESV) (the change of LVESV: -6.4 ± 15.9ml in CON, -20.5 ± 13.3ml in Group A, -19.6 ± 11.1ml in Group B, -9.4 ± 16.3ml in Group C), and significantly greater myocardial perfusion (change from baseline: -4.7 ± 5.7% in CON, -7.8 ± 4.5% in Group A, -7.5 ± 2.9% in Group B, -5.0 ± 4.0% in Group C). Group A and B patients had similar beneficial effects on cardiac function (p = 0.163) and LV geometry (LVEDV: p = 0.685; LVESV: p = 0.622) assessed by echocardiography, whereas Group C showed similar results to those of the CON group. Group B showed more expensive care (p < 0.001) and longer hospital stays during the first month after emergency PCI (p < 0.001) than Group A, with a similar improvement after repeat cardiac catheterization following emergency PCI. Cell therapy in AMI patients that is given within 24 hours is similar to 3-7 days after the primary PCI. (TRN: NCT02425358 , 30 April 2015).