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There are several studies published in different places, especially in Europe, in which stem cells are implanted into different kinds of patients with recent acute myocardial infarction, ischemic cardiac insufficiency, refractory angina, etc. obtaining promising results. Here we will try to summarize them. Intracoronary autologous bone-marrow cell transfer after ST elevation MI BOOST Trial Lancet 2004; 364:141-148 Objective: To evaluate if autologous bone marrow progenitor cell implant after acute myocardial infarction increases systolic ventricular function at 6 months. Patients: Sixty patients with myocardial infarct were successfully treated by primary angioplasty with stent 4 to 8 days before and that do not have various vessels affected or shock. Thirty patients underwent successfully bone marrow stem cells implant and thirty patients were in the control group.

Conclusion: Autologous implant of bone marrow progenitor cells increased the ejection fraction of the left ventricle after the first acute myocardial infarction. There was no increase in the intrastent reestenosis. Intracoronary autologous bone-marrow cell transfer after ST elevation MI BOOST Trial 18 months of follow up Circulation 2006; 113: 1287-1294 Objective: To evaluate the results obtained 18 months after the BOOST trial.

Conclusion: Transcoronary implant of bone marrow progenitor cells is safe and effective, however it can not be assumed that only one dose is capable of improving the ventricular function in a sustained way. Intracoronary progenitor cell injection > 3 month after acute myocardial infarction. TOPCARE-CHD NEJM 2006; 355: 1222-1232 Objective: To evaluate the effect in the ventricular function of intracoronary injection of bone marrow progenitor cells or circulating progenitor cells. Patients: Sixty five patients with more than 3 months after acute myocardial infarction with ST elevation and with ventricular dysfunction.

CPC: Células progenitoras circulantes. (Circulating Progenitor Cells)

CPM: Células progenitoras de médula ósea. (Bone Marrow Progenitor Cells)

Conclusion: The intracoronary injection of bone marrow progenitor cells is associated with a moderate improvement in the ventricular function of patients with more than three months of acute myocardial infarction.

Intracoronary bone marrow derived progenitor cells in acute myocardial infarction REPAIR AMI NEJM 2006; 355: 1210-21

Objective: To evaluate if bone marrow progenitor cells improves left ventricular function in patients with acute myocardial infarction after 4 months of follow up.

Patients: Two hundred and four patients with acute myocardial infarction with ST elevation, 3 to 7 days after successful reperfusion with angioplasty.

Conclusion: The intracoronary administration of bone marrow progenitor cells improves ventricular function in patients with acute myocardial infarction. Apparently, this improvement is greater the lower the basal ventricular function and in patients treated more than five days after infarct.

Intracoronary injection of mononuclear bone marrow cells in acute myocardial infarction ASTAMI NEJM 2006; 355:1199-209

Objective: To evaluate if the intacoronary injection of bone marrow progenitor cells improves left ventricular function in patients with acute myocardial infarction six months after follow up.

Patients: One hundred patients with acute myocardial infarction and ST elevation, 4 to 8 days after successful revascularization with angioplasty.

Conclusion: Intracoronary administration of bone marrow progenitor cells did not demonstrate significant benefits over ventricular function, diastolic diameter or size of the infarcted area.

Bone marrow stem cell transplant associated with aotocoronary bypass for the treatment of ischemic cardiac insufficiency.

Dr. Alfonso Rivasplata

He studied twenty-eight patients with previous infarct and low ejection fraction (20-30%) with an indication of myocardial revascularization surgery. In seventeen of them a bypass surgery was performed in association with bone marrow stem cell implant (study group) and on eleven patients only aortocoronary bypass was performed (control group). Stem cells were injected in the regions without myocardial viability and the bypass in the regions that were viable. 15 months later the results are as follows:

CONCLUSIONS: Stem cell transplant in association with aortocoronary bypass is feasible and safe in patients with previous myocardial infarction and low ejection fraction.

SUMMARY

As can be seen, most of the studies have found an improvement in the left ventricular function, which could reduce mortality and definitely improve quality of life. This improvement can be seen in the increase of the ejection fraction and in the lower increase of the end diastolic diameter with respect to the control group; this means there is less ventricular remodeling. In this studies the safety of the method is demonstrated, there was no increase in intrastent restenosis, arrhythmias or major complications related to the procedure.