Intracoronary Stem Cell Transplantation in Acute Myocardial Infarction

Experimental and clinical studies suggest that necrotic myocardium may have the capacity to regenerate. We have started a clinical study to demonstrate that the intracoronary implantation of stem cells is feasible and safe. The results in our first 5 patients are presented here. We included patients with anterior acute myocardial infarction and isolated stenosis of the left anterior descending artery that was successfully repaired by primary or facilitated angioplasty. Patients received an intracoronary infusion of bone marrow-derived cells 10-15 days after the infarction. The follow-up protocol included low-dose dobutamine echocardiography, magnetic resonance studies and ECG Holter monitoring. The procedure was carried out with no complications. No patient had a cardiac event during the first 6 months. One patient had a transient ischemic attack without sequelae. No arrhythmias were found. Left ventricular end-diastolic volume remained the same at 6 months (159 [25] ml, 157 [16] ml), left ventricular end-systolic volume decreased (77 [22] ml, 65 [16] ml), and the ejection fraction increased (53 [7]%, 58 [8]%) although no statistically significant differences were found. In the 3 patients in whom dobutamine echocardiography ruled out viability, we found a significant reduction in both volumes. Intracoronary bone marrow-derived cell transplantation after an acute myocardial infarction seems to be safe and feasible, and might lead to favorable remodeling. Trabajos experimentales y clínicos sugieren que el tejido necrótico tiene la capacidad de regenerarse. Nuestro grupo ha comenzado un estudio clínico para demostrar que la implantación intracoronaria de células madre es un procedimiento factible y seguro. Presentamos los resultados de nuestros primeros 5 pacientes. Se ha incluido a pacientes con un infarto agudo de miocardio anterior y una lesión única en la descendente anterior reparada mediante angioplastia primaria o facilitada. A los 10-15 días del infarto, se procedió a la extracción de médula ósea. El implante celular se hizo por vía intracoronaria. El protocolo de seguimiento incluye ecocardiografía con dobutamina, resonancia magnética y Holter de ECG basal y a los 6 meses. Ningún paciente ha tenido un evento cardíaco tras 6 meses de seguimiento. En un paciente se observó un accidente isquémico transitorio sin secuelas. No se han demostrado arritmias en ninguno de los pacientes. El volumen telediastólico no varió a los 6 meses (159 ± 25 y 157 ± 16 ml)