A Cochrane review [Abstract] 1 included 33 studies with a total of 1 765 subjects. The studies compared autologous stem/progenitor cells with no autologous stem/progenitor cells in patients diagnosed with acute myocardial infarction.
Stem/progenitor cell treatment was not associated with statistically significant changes in the incidence of mortality (RR 0.70, 95% CI 0.40 to 1.21) or morbidity (the latter measured by re-infarction, hospital re-admission, restenosis and target vessel revascularisation). In short-term follow up, stem cell treatment was observed to improve left ventricular ejection fraction (LVEF) significantly (WMD 2.87, 95% CI 2.00 to 3.73). This improvement in LVEF was maintained over long-term follow up of 12 to 61 months (WMD 3.75, 95% CI 2.57 to 4.93). With certain measurements and at certain times, stem cell treatment was observed to reduce left ventricular end systolic and end diastolic volumes (LVESV & LVEDV) and infarct size significantly in long-term follow up. There was a positive correlation between mononuclear cell dose infused and the effect on LVEF measured by magnetic resonance imaging. A correlation between timing of stem cell treatment and effect on LVEF measured by left ventricular angiography was also observed.
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment and lack of blinding), inconsistency (heterogeneity in interventions and outcomes), and by imprecise results (limited study size for each comparison).
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