%0 Journal Article
%T Total Ischemic Time as an Independent Predictor of Response to Stem Cell Therapy in Patients with ST Segment Elevation Myocardial Infarction
%A Mary Lim
%A Zekeriya Arslan
%A Chunyan Cai
%A Christopher Y. Kim
%A Yong-Jian Geng
%A Ali E. Denktas
%J ISRN Stem Cells
%D 2014
%R 10.1155/2014/293967
%X The selection criteria for bone marrow stem cell (BMSC) therapy are not well established for ST segment elevation myocardial infarction (STEMI) patients. This investigation seeks to utilize total ischemic time (TIT), time of symptom onset to percutaneous coronary intervention (PCI), as a criterion for giving BMSC to STEMI patients. A meta-analysis and metaregression were conducted to evaluate improvement of LVEF with BMSC and its association with TIT (<6 and ¡Ý6 hours) and baseline LVEF (<45% and ¡Ý45%) at short (3¨C6 months) and long term (>6 months) followup. At short term, BMSC allowed improvement of LVEF with prolonged TIT (6.62%, 95% CI, 2.26 to 10.98 for <45%; 6.13%, 95% CI, 2.59 to 9.67 for ¡Ý45%). Similarly, for long term, receiving BMSC allowed significant improvement of LVEF for prolonged TIT (9.19%, 95% CI, 2.34 to 16.05 for <45%; 7.64%, 95% CI, 3.72 to 11.56 for ¡Ý45%). Additionally, TIT was a significant predictor of LVEF improvement independent of baseline LVEF in both short (4.96%, 95% CI, 0.72 to 9.19, ) and long term (6.24%, 95% CI, 0.46 to 12.02, ) followup. Consequently, BMSC therapy allows LVEF improvement in prolonged TIT and future studies for BMSC should include TIT ¡Ý 6 hours as an inclusion criterion. 1. Introduction Autologous bone marrow stem cell (BMSC) injection in patients with ST segment elevation myocardial infarction (STEMI) has been investigated as a new treatment strategy for the past decade. After the first encouraging pilot study [1] in 2002, many trials have since been published. Although several studies failed to show any favorable outcomes from BMSC [2¨C5], there have been many trials which demonstrated the beneficial effects of BMSC [6¨C12]. Several meta-analyses have confirmed that BMSC injections improved left ventricular systolic function, on average, by 3% [13¨C15]. Despite the promising results in these studies, there were many inconsistencies in the selection criteria; incongruent cell types, varying administration time, and variable injection routes are a few examples. Selected patients were also heterogeneous in terms of baseline left ventricular ejection fraction (LVEF) and time from symptom onset to reperfusion. Unfortunately, it is still difficult to identify the best model to demonstrate the effectiveness of stem cell therapy. In this study, we attempted to define an independent parameter which can increase the efficacy of BMSC: we focused on whether the total ischemic time (TIT), defined by the time of symptom onset to the time of percutaneous coronary intervention (PCI), was associated with LVEF improvement
%U http://www.hindawi.com/journals/isrn.stem.cells/2014/293967/