ABSTRACT
BACKGROUND: Left ventricular ejection fraction (LVEF) is a major determinant of long-term prognosis after ST-segment elevation myocardial infarction (STEMI). STEMI patients with reduced LVEF have a poor prognosis, despite successful reperfusion and the use of renin-angiotensin-aldosterone inhibitors. HYPOTHESIS: Intracoronary infusion of bone marrow-derived mononuclear cells (BMMC) may improve LVEF in STEMI patients successfully reperfused. METHODS: The main inclusion criteria for this double-blind, randomized, multicenter study were patient age 30 to 80 years, LVEF ≤50%, successful angioplasty of infarct-related artery, and regional dysfunction in the infarct-related area analyzed before cell injection. Cardiac magnetic resonance imaging was used to assess LVEF, left ventricular volumes, and infarct size at 7 to 9 days and 6 months post-myocardial infarction. RESULTS: One hundred and twenty-one patients were included (66 patients in the BMMC group and 55 patients in the placebo group). The primary endpoint, mean LVEF, was similar between both groups at baseline (44.63% ± 10.74% vs 42.23% ± 10.33%; P = 0.21) and at 6 months (44.74% ± 12.95 % vs 43.50 ± 12.43%; P = 0.59). The groups were also similar regarding the difference between baseline and 6 months (0.11% ± 8.5% vs 1.27% ± 8.93%; P = 0.46). Other parameters of left ventricular remodeling, such as systolic and diastolic volumes, as well as infarct size, were also similar between groups. CONCLUSIONS: In this randomized, multicenter, double-blind trial, BMMC intracoronary infusion did not improve left ventricular remodeling or decrease infarct size.
Subject(s)
Heart Ventricles/diagnostic imaging , ST Elevation Myocardial Infarction/therapy , Stem Cell Transplantation/methods , Stroke Volume/physiology , Ventricular Function, Left/physiology , Ventricular Remodeling/physiology , Adult , Aged , Aged, 80 and over , Double-Blind Method , Female , Follow-Up Studies , Heart Ventricles/physiopathology , Humans , Magnetic Resonance Imaging, Cine , Male , Middle Aged , Prognosis , Retrospective Studies , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/physiopathologyABSTRACT
A terapia percutânea com implante de stents em lesões de enxerto de veia safena tem se apresentado como interessante alternativa a uma nova cirurgia de revascularização do miocárdio, tanto por sua menor morbimortalidade como também por índices des sucesso bem aceitáveis. Entretanto, diversos estudos em artérias coronárias nativas demonstraram que os índices de reestenose estão diretamente relacionados com a extensão do segmento tratado, isto é com a extensão do stent utlizado. Em relação aos enxertos de veia safena esta relação ainda necessita investigação adicional. No Instituto "Dante Pazzanese" de Cardiologia de 1994 a 2001, 352 pacientes revascularizados foram submetidos a implante de stents, sendo subdivididos em dois grupos, de acordo com a extensão dos stents...
