Abstract 9834: Impact of Bone Marrow Cell Therapy on Left Ventricular Function, Structure, and Clinical Outcomes in Patients with Ischemic Heart Disease: A Meta-Analysis

Abstract

Background: The effects of adult bone marrow cell (BMC) therapy on left ventricular (LV) function, remodeling, and clinical outcomes in patients with ischemic heart disease (IHD) remain controversial. We systematically reviewed the effects of BMC therapy on LV ejection fraction (LVEF), LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV), infarct size, and clinical outcomes in patients with IHD. Methods: We searched the MEDLINE, Web of Science, Cochrane Central Register of Controlled Trials, and reference lists of retrieved articles for relevant clinical trials through March 2010. Randomized control trials (RCTs) and cohort studies conducted in patients with IHD were included. Weighted Mean Difference (WMD) for changes in LVEF, LVESV, LVEDV and infarct size were estimated using random effects meta-analysis. Peto odds ratio was calculated for clinical outcomes. Results: A total of 43 studies (enrolling 2,537 patients) out of 1,554 identified studies were included in the final analysis. Compared with the standard treatment group, BMC-treated patients showed a significant increase in LVEF, and significant decrease in LVESV, LVEDV, and infarct size (Table). These findings were significant irrespective of the study design (RCTs vs. Cohort studies), type of IHD (acute myocardial infarction vs. chronic IHD) and duration of follow up. Compared with patients who received standard therapy, BMC-treated patients showed significant decrease in all-cause mortality, cardiac mortality, recurrent MI, and stent thrombosis (Table). Conclusions: The pooled data from this largest meta-analysis of its kind to date show that compared with standard therapy, transplantation of adult BMCs results in significant improvement in LV structure, function and scar size in patients with IHD. In addition, BMC therapy is associated with significant reduction in mortality, recurrent MI and stent thrombosis compared to standard therapy in patients with IHD.