359: Stem cell treatment improves heart function after myocardial infarction

August 29, 2012

PEARLS 359, March 2012, written by Brian R McAvoy.

Clinical question: How effective are adult bone marrow-derived stem cells in treating acute myocardial infarction (AMI)?

Bottom line: Adult bone marrow-derived stem cell treatment seems to be safe and to improve heart function (increased left ventricular ejection fraction and reduced left ventricular end systolic and diastolic volumes and infarct size) moderately but significantly for up to 61 months in patients after an AMI. Nonetheless, there was no evidence of any significant effect on mortality and morbidity (reinfarction, hospital readmission, restenosis and target vessel revascularisation) beyond standard therapy.

Caveat: Limitations of the trials included sample sizes, clinical heterogeneity, lack of more patient-centred outcomes (eg, quality of life) and lack of standardisation of outcome assessment methods. Mortality rates after successful revascularisation of the culprit arteries are very low, and, therefore, a larger number of participants would be required to assess the full clinical effect of this treatment. The stem cell harvest and the isolation of the stem/ progenitor cells accounted for 10% of the total costs of the trials. Consequently, this treatment is only currently available in research-associated facilities.

Context: Stem cell therapy offers a promising approach to the regeneration of damaged vascular and cardiac tissue after an AMI.

Cochrane Systematic Review: Clifford DM et al. Stem cell treatment for acute myocardial infarction. Cochrane Reviews, 2012, Issue 2. Article No. CD006536. DOI: 10.1002/14651858.CD006536.pub3. This review contains 33 studies involving 1765 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.