Comparative evaluation of long-term clinical efficacy with catheter-based percutaneous intramyocardial autologous bone marrow cell implantation versus laser myocardial revascularization in patients with severe coronary artery disease - 16/08/11
, Sukumaran Thambar, MBBS b, Yok-Lam Kwong, MD a, Philip Rowlings, MBBS b, Greg Bellamy, MBBS b, Jane McCrohon, MBBS b, Bruce Bastian, MBBS b, John K.F. Chan, MBBS c, Gladys Lo, MD c, Chi-Lai Ho, MBBS d, Anthony Parker, MD, PhD e, Thomas H. Hauser, MD f, Chu-Pak Lau, MD aRésumé |
Background |
Catheter-based percutaneous laser myocardial revascularization (PMR) and intramyocardial direct bone marrow (BM) cell implantation have been investigated to treat patients with severe coronary artery disease (CAD). In both therapeutic approaches, direct local myocardial injury might be a common mechanism to induce therapeutic angiogenesis.
Methods |
We studied the long-term clinical outcome in 16 patients with severe CAD who received either catheter-based PMR (n = 8) or intramyocardial autologous BM cell implantation (n = 8) as guided by electromechanical mapping.
Results |
There were no significant differences in the baseline characteristics and the number of injection versus the number of laser pulse delivered between the 2 groups (P > .05). As compared with baseline, the New York Heart Association functional class and the number of anginal episodes were significantly reduced at 3- and 6-month follow-up in both BM and PMR groups (P < .05). However, the improvement in the New York Heart Association class and the reduction in anginal episodes at 18 months were only persisted in the BM group (P < .05) but not in the PMR group (P > .05). Furthermore, there were significant improvements in exercise time at 6- and 18-month follow-up, and the extent of stress-induced perfusion single-photon emission computed tomography defects at 6-month follow-up in BM group, as compared with baseline (all P < .05), but not in the PMR group (all P > .05). As compared with baseline, there were no significant changes in the total quality of life scores during follow-up in both groups (all P > .05).
Conclusions |
The results of this study demonstrated that the catheter-based intramyocardial autologous BM cell implantation might be more effective than PMR in improving symptoms and exercise capacity in patients with severe CAD. The beneficial effect of direct intramyocardial injection was over and beyond those noted in patients treated with PMR, suggesting a potential direct therapeutic effect of BM cells, rather than local myocardial injury alone on chronic ischemic myocardium.
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| This study was supported by the Sun Chieh Yeh Heart Foundation Fund, SK Yee Medical Foundation grant (project no. 203217), and The Research Grants Council of Hong Kong (HKU 7357/02M) from Hong Kong. There was no external industry sponsor involved in study design, data collection, data analysis, data interpretation, or writing of the report. |
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| HF Tse received consultant fee from Biosense-Webster, Diamond Bar, CA. All other authors declare that they have no conflict of interest. |
Vol 154 - N° 5
P. 982.e1-982.e6 - novembre 2007 Retour au numéro
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