Autologous bone-marrow cells improve left-ventricular function in patients after AMI: BOOST

The first randomized trial of stem-cell transfer in the heart, has been published in the Lancet. Results from the BOOST trial show an improvement in left-ventricular function in MI patients undergoing the procedure.The researchers note that emerging evidence suggests that stem cells and progenitor cells derived from bone marrow can be used to improve cardiac function in patients after acute myocardial infarction. Led by Dr Kai Wollert (Hanover Medical School, Germany), they conducted a randomized trial in order to assess whether intracoronary transfer of autologous bone-marrow cells could improve global left-ventricular ejection fraction (LVEF) at 6 months' follow-up.After successful percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction, 60 patients were randomly assigned to either a control group (n=30) that received optimum postinfarction medical treatment, or a bone-marrow-cell group (n=30) that received optimum medical treatment and intracoronary transfer of autologous bone-marrow cells 4.8 days after PCI. The primary end point was global left-ventricular ejection fraction (LVEF) change from baseline to six-month follow-up, as determined by cardiac MRI. This increased by 0.7% in the control group and 6.7% in the bone-marrow-cell group (p=0.0026).Transfer of bone-marrow cells enhanced left-ventricular systolic function primarily in myocardial segments adjacent to the infarcted area. But left-ventricular end diastolic volumes did not decrease, indicating that transfer of bone-marrow cells did not improve left-ventricular remodeling at six months. Cell transfer did not increase the risk of adverse clinical events, in-stent restenosis, or proarrhythmic effects.Wollert and colleagues conclude "our results lend support to the concept that autologous bone-marrow cells can be used to enhance left-ventricular functional recovery in patients after acute myocardial infarction." They add, however, that larger trials are needed to address the effect of bone-marrow-cell transfer on clinical end points such as the incidence of heart failure and survival.Reference...