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Bone marrow-derived cells as safe as coronary angiogram for acute MI, chronic HF
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Intracoronary infusion of progenitor cells is safe in patients with acute MI or chronic HF, with a safety profile similar to that of a coronary angiogram, study results found.
Researchers at a single center in Germany analyzed periprocedural complications and 30-day outcomes of intracoronary administration of progenitor cells. The procedure utilized an over-the-wire balloon catheter (oversized by 0.5 mm) that was advanced into the proximal target vessel and the stop-flow technique to allow adhesion and potential transmigration of infused cells. In all, researchers performed 775 consecutive intracoronary administrations, of which 126 were performed in patients with acute MI, 562 in patients with ischemic chronic HF and 87 in patients with nonischemic chronic HF.
There were no procedural deaths, although vessel injury occurred in nine procedures (1.2%), requiring additional PCI in eight cases.
Troponin T increased during the procedure in 3.2% of the chronic HF procedures in which no concomitant PCI had been performed and troponin levels were not elevated before the procedure.
Independent predictors of troponin T increase included NYHA class (NYHA I vs. NYHA IV, P=.01; NYHA I vs. III, P=.19; NYHA I vs. II, P=.55). Other independent predictors included concomitant revascularization (P<.01), presence of elevated troponin T before the procedure (P<.01) and peripheral occlusive disease (P=.04).
“The overall complication rate of 1.1% for the sole intracoronary application of autologous [bone marrow–derived mononuclear cells] or circulating progenitor cell compares favorably with complication rates reported for diagnostic coronary angiography,” the researchers wrote. “Moreover, no-reflow or slow-flow was only observed in four procedures, of which three were accompanied by concomitant [progenitor cell injection]. However, cell application into a bypass graft was associated with a higher procedural risk for complications as compared with cell application into a native coronary vessel.”
Disclosure: The researchers report no relevant financial disclosures.
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