Intramyocardial bone marrow cell injection for ischemic heart disease: efficacy analysis and long term follow-up

摘要

Despite optimal medical treatment and advanced revascularization strategies, a growing number of patients suffer from severe coronary artery disease not amenable to conventional treatment options. Bone marrow cell injection has emerged as a new potential therapeutic option for these patients. As preclinical studies provided evidence for improvement in myocardial perfusion and function after transplantation of cells, cell therapy was introduced in the clinical setting. As initial studies demonstrated promising results, intramyocardial injection of autologous bone marrow-derived mononuclear cells emerged as a new therapeutic option for patients with severe coronary artery disease. Although studies demonstrated safety and feasibility of the approach, the overall effect of bone marrow cell treatment has shown moderately positive but variable effects. However, many questions remain whether there are certain factors, such as patient specific characteristics, that influence treatment outcome. Therefore, in the current thesis, the efficacy of bone marrow cell injection was investigated in a large refractory angina patient population with chronic myocardial ischemia to further evaluate treatment effect during short and long term follow-up. In addition, the safety and effect of autologous mesenchymal stem cells injection, a specific bone marrow-derived cell type, in patients shorty after acute myocardial infarction was evaluated.