The clinical study of autologous peripheral blood stem cell transplantation by intracoronory infusion in patients with acute myocardial infarction (AMI)

Abstract

Purpose To investigate the effects and safety of autologous peripheral blood stem cell (PBSCs) transplantation by intracoronory infusion in patients with acute myocardial infarction (AMI). Methods 70 patients with AMI were allocated to two groups, one was PBSCs transplantation group ( n = 35) that received optimal post-infarction medical treatment (standard drug and coronary artery intervention therapy) and intracoronary transplantation of PBSCs; the other was control group ( n = 35) that received optimum post-infarction medical treatment (standard drug and coronary artery intervention therapy). The PBSCs transplantation group received granulocyte colony-stimulating factor (G-CSF: Filgrastim, 300 μg) with the dose of 300–600 μg/day to mobilize the stem cell, and the duration of administration G-CSF was 5 days. On the sixth day, PBSCs were separated by Baxter CS 3000 blood cell separator into suspend liquid 57 ml. Then, the suspend liquid was transferred into the infarct-related artery (IRA) by occluding the over-the-wire balloon and infusing artery through balloon center lumen. In the process of the mobilization, separation and intracoronary infusion of PBSCs, the complications have been investigated. Changes in left ventricular function were assessed at 6-month follow-up. Results 35 cases had finished follow-up in the treated group, while 23 cases in control group. After 6 months, within the treated group, there was a significant improvement in global left ventricular function ejection fraction (EF) from a baseline of 50.0 ± 8.2% to 57.1 ± 7.8% ( P < 0.0001), wall motion score index (WMSI) from 1.219 ± 0.190 to 1.101 ± 0.118 ( P < 0.0001), left end-systolic volume (ESV) from 63.8 ± 23.9 ml to 52.6 ± 20.3 ml ( P = 0.01) and left end-diastolic volume (EDV) from 134.2 ± 36.7 ml to 119.2 ± 30.3 ml ( P = 0.07); in the control group, there was no significant improvement in EF, WISM, EDV and ESV ( P = 0.490, 0.259, 0.117, 0.395). After 6-month follow-up, according to treatment group vs. control group, there was a significant improvement in EF from 57.1 ± 7.8 to 52.6 ± 5.7 ( P = 0.041) and WISM from 1.101 ± 0.118 to 1.184 ± 0.138 ( P = 0.034). There were a total of 25 cases with complications during the mobilization, separating and infusion of PBSC. The incidence of complications relating to mobilization was 37.1% (13/35), relating to separating was 14.3% (5/35) and relating to intracoronary infusion was 20.0% (7/35). No death was observed. Conclusion Autologous PBSCs transplantation by intracoronary infusion is feasible and safe, and it can improve left ventricular function in the 6-month follow-up.