Long-term clinical results of autologous bone marrow mononuclear cell transplantation in patients with acute myocardial infarction

The aim of the study was to investigate the long-term results of autologous bone marrow mononuclear cell transplantation in patients with acute myocardial infarction. A total of 62 patients with primary acute myocardial infarction who were admitted to the hospital from 2003 to 2006 were included in the open randomized study registered under the title ESTABOMA. Inclusion criteria were primary ST segment elevation acute myocardial infarction and time to reperfusion of the infarct-related coronary artery from acute myocardial infarction onset not shorter than 4 h. All patients were randomized to two groups: group 1 (main group) included patients who received infarct-related coronary artery stenting and cellular cardiomyoplasty at 20±10 days after onset of acute myocardial infarction (n=28); group 2 (control group) included patients with infarct-related coronary artery stenting at 20±10 days after onset of acute myocardial infarction (n=34). Follow-up study was performed 8.23±0.72 years after acute myocardial infarction and consisted in the evaluation of clinical course of coronary artery disease, physical examination, exercise tolerance assessment by 6-min walking test, and serum BNP test. Adherence of patients to recommended drug treatment was assessed via the Morisky-Green test. Information about vital status of 58 patients (93%) including 26 patients of main group and 32 patients of control group was obtained. In main group, both total and cardiovascular lethality rates were higher compared with those in control group: 10 (36%) versus 4 (12%) (p=0.01) and 8 (29%) vs. 2 (6%), (p=0.03), respectively. Chronic heart failure of functional class II and higher was found more often in second group: 6 (31%) vs. 10 (21%), (р=0.05). In accordance with this, diagnoses of chronic heart failure of functional classes IIA and IIB were established more often in the second group: 8 (29%) vs. 3 (9%), (р=0.05). During eight-year follow-up period, control group had higher frequency of hospitalizations due to cardiovascular disease including unstable angina: 12 (37.5%) vs. 5 (19%), (p=0.035). The study found intergroup difference in the following combined end point: lethal outcomes due to cardiovascular disease + second acute myocardial infarction + chronic heart failure of functional class II and higher; these clinical events were significantly more frequent and occurred significantly earlier in main group (p=0.04). However, no differences in exercise tolerance and BNP levels were found. The study did not show positive effects of autologous bone marrow mononuclear cell transplantation on the long-term survival of patients. However, clinically significant chronic heart failure and diagnosed unstable angina were detected less frequently among patients of the main group who underwent follow-up examination.