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Meta-Analysis of Cell-based CaRdiac stUdiEs (ACCRUE) in Patients With Acute Myocardial Infarction Based on Individual Patient Data

Authors: Gyöngyösi, Mariann; Wojakowski, Wojciech; Lemarchand, Patricia; Lunde, Ketil; Tendera, Michal; Bartunek, Jozef; Marban, Eduardo; +30 Authors

Meta-Analysis of Cell-based CaRdiac stUdiEs (ACCRUE) in Patients With Acute Myocardial Infarction Based on Individual Patient Data

Abstract

Rationale : The meta-Analysis of Cell-based CaRdiac study is the first prospectively declared collaborative multinational database, including individual data of patients with ischemic heart disease treated with cell therapy. Objective : We analyzed the safety and efficacy of intracoronary cell therapy after acute myocardial infarction (AMI), including individual patient data from 12 randomized trials (ASTAMI, Aalst, BOOST, BONAMI, CADUCEUS, FINCELL, REGENT, REPAIR-AMI, SCAMI, SWISS-AMI, TIME, LATE-TIME; n=1252). Methods and Results : The primary end point was freedom from combined major adverse cardiac and cerebrovascular events (including all-cause death, AMI recurrance, stroke, and target vessel revascularization). The secondary end point was freedom from hard clinical end points (death, AMI recurrence, or stroke), assessed with random-effects meta-analyses and Cox regressions for interactions. Secondary efficacy end points included changes in end-diastolic volume, end-systolic volume, and ejection fraction, analyzed with random-effects meta-analyses and ANCOVA. We reported weighted mean differences between cell therapy and control groups. No effect of cell therapy on major adverse cardiac and cerebrovascular events (14.0% versus 16.3%; hazard ratio, 0.86; 95% confidence interval, 0.63–1.18) or death (1.4% versus 2.1%) or death/AMI recurrence/stroke (2.9% versus 4.7%) was identified in comparison with controls. No changes in ejection fraction (mean difference: 0.96%; 95% confidence interval, −0.2 to 2.1), end-diastolic volume, or systolic volume were observed compared with controls. These results were not influenced by anterior AMI location, reduced baseline ejection fraction, or the use of MRI for assessing left ventricular parameters. Conclusions : This meta-analysis of individual patient data from randomized trials in patients with recent AMI revealed that intracoronary cell therapy provided no benefit, in terms of clinical events or changes in left ventricular function. Clinical Trial Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01098591.

Keywords

Male, MESH: Chi-Square Distribution, Time Factors, Databases, Factual, MESH: Myocardial Contraction, analysis, Left, Myocardial Infarction, heart failure, Kaplan-Meier Estimate, MESH: Stroke Volume, Ventricular Function, Left, MESH: Proportional Hazards Models, MESH: Risk Factors, Risk Factors, Recurrence, Ventricular Function, Prospective Studies, MESH: Bone Marrow Transplantation, MESH: Treatment Outcome, Bone Marrow Transplantation, Randomized Controlled Trials as Topic, MESH: Aged, MESH: Middle Aged, Ventricular Remodeling, MESH: Regeneration, Middle Aged, MESH: Recovery of Function, MESH: Myocardial Infarction, Treatment Outcome, MESH: Cerebrovascular Disorders, Female, MESH: Myocardium, 610, MESH: Ventricular Remodeling, 610 Medicine & health, [SDV.BC]Life Sciences [q-bio]/Cellular Biology, meta, MESH: Databases, 11171 Cardiocentro Ticino, 2705 Cardiology and Cardiovascular Medicine, Disease-Free Survival, Databases, stem cells, MESH: Ventricular Function, Humans, Regeneration, outcome assessment, [SDV.BC] Life Sciences [q-bio]/Cellular Biology, MESH: Kaplan-Meier Estimate, Factual, Aged, Proportional Hazards Models, MESH: Humans, Chi-Square Distribution, Myocardium, MESH: Time Factors, Stroke Volume, 1314 Physiology, Recovery of Function, Myocardial Contraction, MESH: Male, MESH: Prospective Studies, anterior wall myocardial infarction, MESH: Recurrence, meta-analysis, Cerebrovascular Disorders, MESH: Randomized Controlled Trials as Topic, MESH: Disease-Free Survival, MESH: Female

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    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
264
Top 1%
Top 1%
Top 0.1%
Green
bronze