Efficacy and Safety of Bone Marrow Cell Transplantation for Chronic Ischemic Heart Disease: A Meta-Analysis
Chun Xiao, Shijie Zhou, Yueqiang Liu, Huozhen Hu
Department of Medicine, Sichuan Scientific & Cellular Biotechnology Research Institute, Chengdu, China (mainland)
Med Sci Monit 2014; 20:1768-1777
Background: Although bone marrow-derived cells (BMCs) have shown great therapeutic potential in patients with chronic ischemic heart disease (CIHD), the exact efficacy and safety of BMCs therapy is still not completely defined
Material/Methods: We searched PubMed, OVID, EMBASE, the Cochrane Library, and ClinicalTrials.gov and finally identified 20 qualified trials in this meta-analysis. Assessment of efficacy was based on left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), and left ventricular end-diastolic volume (LVEDV) improvement, by weighted mean difference (WMD) with 95% confidence intervals (CIs). Results of all-cause death, ventricular arrhythmia, recurrent myocardial infarction, and cerebrovascular accident were pooled to assess safety. Subgroup analysis was performed by stratifying RCTs into 2 subgroups of those with revascularization and without revascularization.
Results: BMC transplantation significantly improved LVEF in patients with revascularization (3.35%, 95% CI 0.72% to 5.97%, p=0.01; I2=85%) and without revascularization (3.05%, 95% CI 0.65% to 5.45%, p=0.01; I2=86%). In patients without revascularization, BMC transplantation was associated with significantly decreased LVESV (–11.75 ml, 95% CI –17.81 ml to –5.69 ml, p=0.0001; I2=81%), and LVEDV (–7.80 ml, 95% CI –15.31 ml to –0.29 ml, p=0.04; I2=39%). Subgroup analysis showed that the route of transplantation, baseline LVEF, and type of cells delivered could influence the efficacy of BMC transplantation.
Conclusions: Autologous transplantation of BMCs was safe and effective for patients who were candidates for revascularization with CABG/PCI and those who were not. However, large clinical trials and long-term follow-up are required to confirm these benefits.
Keywords: Bone Marrow Transplantation - adverse effects, Chronic Disease, Diastole, Myocardial Ischemia - therapy, Publication Bias, Stroke Volume, Systole, Ventricular Function, Left