Janssens S et al. (2006) Autologous bone marrow-derived stem-cell transfer in patients with ST-segment elevation myocardial infarction: double-blind, randomised controlled trial. Lancet 367: 113–121

Despite the benefit of reperfusion therapies, ST-segment elevation myocardial infarction (STEMI) is associated with a loss of viable myocardium and left ventricular (LV) function. Intracoronary transfer of autologous stem cells from bone marrow might improve LV remodeling and function following STEMI, but trials investigating this procedure have not included appropriate placebo control groups. Janssens and coauthors compared the effects of intracoronary stem-cell transfer with those of placebo transfer.

In this randomized, double-blind study, stem cells were harvested from the bone marrow of patients 1 day after percutaneous coronary intervention for STEMI. Patients received optimal medical therapy plus placebo (n = 34) or stem-cell transfer (n = 33). After 4 months of follow-up, LV ejection fractions had improved by similar amounts in both groups. Although at 2 months systolic function was better in stem-cell recipients than in placebo recipients, at 4 months the groups did not differ. The infarct size decreased more from baseline to 4 months in patients receiving stem cells than in those receiving placebo (treatment effect 28%, P = 0.036), but no differences were noted between the groups in myocardial metabolism or perfusion.

The authors conclude that intracoronary stem-cell transfer does not improve global LV function more than standard reperfusion therapy alone. The decreased infarct volume with stem cells and the resulting improved regional contractile function in the most-severely infarcted segments suggests that this therapy could facilitate infarct remodeling.