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Percutaneous coronary intervention in acute myocardial infarction: from
procedural considerations to long term outcomes
Delewi, R.
Publication date
2015
Document Version
Final published version
Link to publication
Citation for published version (APA):
Delewi, R. (2015). Percutaneous coronary intervention in acute myocardial infarction: from
procedural considerations to long term outcomes. Boxpress.
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257
Letter by Delewi et al.
13
Chapter 13
letter by Delewi et al. regarding article “Adult
Bone Marrow Cell Therapy Improves Survival
and Induces long-Term Improvement in Cardiac
Parameters: A Systematic Review and
Meta-Analysis”
Ronak Delewi, Jan J. Piek, Alexander Hirsch
258
Chapter 13
To the Editor
Jeevanantham et al. present an interesting and comprehensive meta-analysis on adult bone marrow cell (BMC) therapy in patients with ischemic heart disease.1 A total of 50
studies (enrolling 2,625 patients with acute myocardial infarction or chronic ischemic heart disease) identified by database searches through January 2012 were included. We have read the article with great interest and appreciate its contribution to our current understanding of BMC therapy in patients with coronary artery disease. However, we feel that some aspects of the study merit further discussion.
As stated by the authors in the method section they included 1) randomized controlled trials or cohort studies with a control group; (2) studies conducted in patients with acute myocardial infarction or chronic ischemic heart disease; (3) studies conducted in patients who received percutaneous coronary intervention or thrombolysis or coronary artery bypass surgery; and (4) studies in which patients in the intervention arm received BMC therapy either via intracoronary injection or intramyocardial injection. Considering these criteria it is unclear why 3 of the largest randomized controlled trials (Bonami trial, HEBE trial, Regent trial) on intracoronary cell therapy in acute myocardial infarction are not included in this meta-analysis.2-4 These trials included respectively 200, 200 and
101 patients. In the present meta-analysis, there are only a few randomized controlled trials with comparable sample size and including these studies would have increased the sample size by ≈20%. None of these three trials showed a benefit of cell therapy with regard to left ventricular ejection fraction and volumes. Potentially, including these trials would change the overall results of the meta-analysis. In addition, one study seems to be included twice (Janssens et al and Herbots et al). It appears that MRI and echo data from the same study population of 67 patients is reported in two separate papers.5
Also, the authors conducted several subgroup analyses including the number and type of injected BMCs attempting to identify the potential factors that may influence the observed benefits. We agree with the authors that these are important questions. However, the processes that occur in the myocardium early after myocardial injury differ substantially from the chronic situation. The supposed mechanisms of cell therapy (i.e. enhanced angiogenesis, reduction in apoptosis, activation of cardiac stem cells) may differ in patients with an acute myocardial infarction as compared to patients with ischemic cardiomyopathy. Separate subgroup analyses for these distinct entities could provide a clearer picture of the potential benefit of BMC therapy and increase the impact of the presented data even more.
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Letter by Delewi et al.
13
REFERENCE lIST
(1) Jeevanantham V, Butler M, Saad A, Abdel-Latif A, Zuba-Surma EK, Dawn B. Adult bone marrow cell therapy improves survival and induces long-term improvement in cardiac parameters: a systematic review and meta-analysis. Circulation 2012 31;126:551-68.
(2). Roncalli J, Mouquet F, Piot C, Trochu JN, Le CP, Neuder Y, Le TT, Agostini D, Gaxotte V, Sportouch C, Galinier M, Crochet D, Teiger E, Richard MJ, Polge AS, Beregi JP, Manrique A, Carrie D, Susen S, Klein B, Parini A, Lamirault G, Croisille P, Rouard H, Bourin P, Nguyen JM, Delasalle B, Vanzetto G, Van BE, Lemarchand P. Intracoronary autologous mononucleated bone marrow cell infusion for acute myocardial infarction: results of the randomized multicenter BONAMI trial. Eur Heart J 2011;32:1748-57.
(3). Hirsch A, Nijveldt R, van der Vleuten PA, Tijssen JG, van der Giessen WJ, Tio RA, Waltenberger J, ten Berg JM, Doevendans PA, Aengevaeren WR, Zwaginga JJ, Biemond BJ, van Rossum AC, Piek JJ, Zijlstra F. Intracoronary infusion of mononuclear cells from bone marrow or peripheral blood compared with standard therapy in patients after acute myocardial infarction treated by primary percutaneous coronary intervention: results of the randomized controlled HEBE trial. Eur Heart J 2011;32:1736-47.
(4). Tendera M, Wojakowski W, Ruzyllo W, Chojnowska L, Kepka C, Tracz W, Musialek P, Piwowarska W, Nessler J, Buszman P, Grajek S, Breborowicz P, Majka M, Ratajczak MZ. Intracoronary infusion of bone marrow-derived selected CD34+CXCR4+ cells and non-selected mononuclear cells in patients with acute STEMI and reduced left ventricular ejection fraction: results of randomized, multicentre Myocardial Regeneration by Intracoronary Infusion of Selected Population of Stem Cells in Acute Myocardial Infarction (REGENT) Trial. Eur Heart J 2009;30:1313-21.
(5). Herbots L, D’hooge J, Eroglu E, Thijs D, Ganame J, Claus P, Dubois C, Theunissen K, Bogaert J, Dens J, Kalantzi M, Dymarkowski S, Bijnens B, Belmans A, Boogaerts M, Sutherland G, Van de Werf F, Rademakers F, Janssens S. Improved regional function after autologous bone marrow-derived stem cell transfer in patients with acute myocardial infarction: a randomized, double-blind strain rate imaging study. Eur Heart J 2009;30:662-70.
