prognosis of patients with Acute Myocardial Infarction remains dismal.

Slides:



Advertisements
Similar presentations
STEM-AMI OUTCOME TRIAL STem cElls Mobilization in Acute Myocardial Infarction Outcome Trial   A national, multicentre, randomised, open-label, Phase.
Advertisements

Jay H. Traverse, MD Principal Investigator, TIME Study Minneapolis Heart Institute at Abbott Northwestern Hospital University of Minnesota Medical School.
Allen Jeremias MD MSc, Sanjay Kaul MD, Luis Gruberg MD, Todd K. Rosengart MD, David L. Brown MD Divisions of Cardiovascular Medicine and Cardiothoracic.
Myocardial Repair by Percutaneous Cell Transplantation of Autologous Skeletal Myoblast as a Stand Alone Procedure in Post Myocardial Infarction Chronic.
Effects of selective heart rate reduction with ivabradine on left ventricular remodelling and function: results from the SHIFT echocardiography substudy.
Intracoronary Autologous Bone-Marrow Cell Transfer after Myocardial Infarction: A Double-Blind, Randomized, and Placebo-Controlled Clinical Trial Presented.
Jay H. Traverse, MD Principal Investigator, TIME Study Minneapolis Heart Institute at Abbott Northwestern Hospital University of Minnesota Medical School.
Implementation of ESC/ACC Definition of Myocardial Infarction in Contemporary, Large RCTs: A Systematic Review Sergio Leonardi, L. Kristin Newby, E. Magnus.
Giuseppe Biondi-Zoccai Division of Cardiology, University of Turin, Turin, Italy.
Efficacy and safety of angiotensin receptor blockers: a meta-analysis of randomized trials Elgendy IY et al. Am J Hypertens. 2014; doi:10,1093/ajh/hpu209.
Glucose – Insulin – Potassium Study in Patients with ST Elevation Myocardial Infarction without Signs of Heart Failure Presented at American College of.
E. McLaughlin, P. D. Chakravarty, D. Whittaker, E. Cowan, K. Xu, E. Byrne, D.M. Bruce, J. A. Ford University of Aberdeen.
Is Direct Stenting Superior to Stenting with Predilation in Patients Treated with Percutaneous Coronary Intervention? Results from a Meta-Analysis of 24.
University Medical Center Groningen Thrombus aspiration during primary PCI FZ Thrombus Aspiration during Percutaneous coronary intervention in Acute.
COURAGE: Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation Purpose To compare the efficacy of optimal medical therapy (OMT)
CHARM-Preserved: Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity - Preserved Purpose To determine whether the angiotensin.
BEAUTI f UL: morBidity-mortality EvAlUaTion of the I f inhibitor ivabradine in patients with coronary disease and left ventricULar dysfunction Purpose.
Francesco Liistro Cardiovascular Department, Arezzo, Italy Impact of Thrombus Aspiration on Myocardial Tissue Reperfusion and Left Ventricular Functional.
Published in Circulation 2005 Percutaneous Coronary Intervention Versus Conservative Therapy in Nonacute Coronary Artery Disease: A Meta-Analysis Demosthenes.
Jay H. Traverse, MD Principal Investigator, TIME Study Minneapolis Heart Institute at Abbott Northwestern Hospital University of Minnesota Medical School.
Effects of PG , a Matrix Metalloproteinase Inhibitor to Prevent Left Ventricular Remodeling After Acute Myocardial Infarction Effects of PG ,
A Systematic Review On The Hazards Of Aspirin Discontinuation Among Patients With Or At Risk For Coronary Artery Disease Giuseppe Biondi Zoccai Hemodynamics.
Author: Moldovan Carmen Co-authors: Opincariu Diana Balan Daniel University of Medicine and Pharmacy Tg. Mures Cardiology Clinic, Mures Emergency Clinical.
Ten-Year Follow-up Survival of the Medicine, Angioplasty, or Surgery Study (MASS-II): a Randomized Controlled Clinical Trial of Therapeutic Strategies.
Murat Sezer, Emre Aslanger, Arif Cimen, Ebru Yormaz, Cuneyt Turkmen, Berrin Umman, Yılmaz Nisanci, Zehra Bugra and Sabahattin Umman Istanbul University,
Elective Stenting versus Balloon Angioplasty with Bail-out Stenting for Small Vessel Coronary Artery Disease: Evidence from a Meta-analysis of Randomized.
1 Lecture 10: Meta-analysis of intervention studies Introduction to meta-analysis Selection of studies Abstraction of information Quality scores Methods.
Safety and effectiveness of granulocyte-colony stimulating factor in advanced chronic heart failure Jacob Joseph, MD Veterans Affairs Healthcare System-
Can we better protect patients who undergo revascularization? Beneficial effects of short- and long-term trimetazidine MR therapy in patients undergoing.
Jay H Traverse, MD Principal Investigator, LateTIME Study Minneapolis Heart Institute at Abbott Northwestern Hospital University of Minnesota Medical School.
Late Open Artery Hypothesis Jason S. Finkelstein, M.D. Tulane University Medical Center 2/24/03.
Rosuvastatin 10 mg n=2514 Placebo n= to 4 weeks Randomization 6weeks3 monthly Closing date 20 May 2007 Eligibility Optimal HF treatment instituted.
Date of download: 5/27/2016 Copyright © The American College of Cardiology. All rights reserved. From: A Randomized Trial to Assess Catheter Ablation Versus.
Is there any role for intravascular ultrasound in bifurcation lesions? Giuseppe Biondi-Zoccai, MD University of Turin, Turin, Italy.
Date of download: 6/3/2016 Copyright © The American College of Cardiology. All rights reserved. From: Survival of patients with diabetes and multivessel.
2 years versus 1 year of adjuvant trastuzumab for HER2-positive breast cancer (HERA): an open-label, randomised controlled trial Aron Goldhirsch, Richard.
Ten Year Outcome of Coronary Artery Bypass Graft Surgery Versus Medical Therapy in Patients with Ischemic Cardiomyopathy Results of the Surgical Treatment.
Effect of Thrombus Aspiration in Patients With Myocardial Infarction Presenting Late After Symptom Onset Steffen Desch, MD Thomas Stiermaier, MD; Suzanne.
Date of download: 6/24/2016 Copyright © The American College of Cardiology. All rights reserved. From: The Year in Cardiovascular Surgery J Am Coll Cardiol.
IN THE NAME OF GOD. What are Stem Cells? Stem cells are a class of undifferentiated cells that are able to differentiate into specialized cell types.
Date of download: 7/1/2016 Copyright © The American College of Cardiology. All rights reserved. From: The Scope of Coronary Heart Disease in Patients With.
Date of download: 7/5/2016 Copyright © The American College of Cardiology. All rights reserved. From: Cardiopoietic Stem Cell Therapy in Heart Failure:
Date of download: 7/7/2016 Copyright © The American College of Cardiology. All rights reserved. From: Stem Cell Mobilization by Granulocyte Colony-Stimulating.
1 R1 임준욱 Anticoagulant and Antiplatelet Therapy Use in 426 Patients With Atrial Fibrillation Undergoing Percutaneous Coronary Intervention and Stent Implantation.
Date of download: 11/11/2016 Copyright © The American College of Cardiology. All rights reserved. From: Targeted Left Ventricular Lead Placement to Guide.
Intramyocardial bone marrow mononuclear cell transplantation in ischemic heart failure: Long-term follow-up  Miia Lehtinen, MD, Tommi Pätilä, MD, PhD,
The TIME Randomized Trial:
Total Occlusion Study of Canada (TOSCA-2) Trial
The NHLBI TIME Trial: Role of Microvascular Obstruction in 2-Year Clinical and MRI Follow-up Jay H. Traverse, MD Principal Investigator, TIME Study Minneapolis.
Angiotensin converting enzyme inhibitors / angiotensin receptor blockers and contrast induced nephropathy in patients receiving cardiac catheterization:
Subgroup analyses for mortality after treatment with coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI). LAD, left anterior.
– р<0.05 between baseline
Revascularization in Patients With Left Ventricular Dysfunction:
Patient clinical characteristics (n=123)
Optimal Pacing for Right Ventricular and Biventricular Devices
Giuseppe Biondi Zoccai
Intramyocardial bone marrow stem cell transplantation during coronary artery bypass surgery: A meta-analysis  Peter Donndorf, MD, Guenther Kundt, PhD,
Cardiac Cell Repair Therapy: A Clinical Perspective
Do higher-risk patients benefit from off-pump coronary artery bypass grafting? Evidence from an ecologic analysis of randomized trials  Oliver Kuss, PhD,
European Society of Cardiology 2003
National Quality Assessment Evaluating Spironolactone Use During Hospitalization for Acute Myocardial Infarction (AMI) in China: China Patient-centered.
Mirnela Byku, and Douglas L. Mann BTS 2016;1:95-106
AN INTERNATIONAL COLLABORATIVE META-ANALYSIS ON 1,274 PATIENTS UNDERGOING PERCUTANEOUS DRUG-ELUTING STENTING FOR UNPROTECTED LEFT MAIN CORONARY ARTERY.
Randomized Study of Mononuclear Bone Marrow Cell Transplantation in Patients With Coronary Surgery  Qiang Zhao, MD, Yongxin Sun, MD, Limin Xia, MD, Anqing.
Clinical trials of intracoronary bone marrow cell transfer after myocardial infarction: The Hannover experience  Helmut Drexler  Biology of Blood and.
Volume 9, Issue 6, Pages (June 2012)
قطب قلب اصفهان 12/8/2016.
Atlantic Cardiovascular Patient Outcomes Research Team
Average left ventricular ejection fraction (LVEF) values during the 1 year of observation in patients with preserved systolic function (LVEF >40%) and.
A model of variation and accelerating factors in the process of acute care chain of patients with STEMI going for primary PCI. PCI, percutaneous coronary.
Presentation transcript:

prognosis of patients with Acute Myocardial Infarction remains dismal

Stem Cell Therapy

The impact on: LEFT VENTRICULAR FUNCTION LEFT VENTRICULAR FUNCTION INFARCT SIZE INFARCT SIZE LV DIMENSIONS LV DIMENSIONS ….remains unclear. ….remains unclear.

OUTCOME OF INTRACORONARY STEM CELL THERAPY IN ACUTE MYOCARDIAL INFARCTION: META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS Arvisminda Luz G. Fernandez, MD. Chong Hua Hospital – Heart Institute May 24, 2012

General Objectives: To perform a meta-analysis on the impact of intracoronary bone marrow stem cell therapy in acute myocardial infarction

to assess if there is significant difference in the LV ejection fraction in patients with acute myocardial infarction who received bone marrow therapy versus control. to assess if there is significant difference in the LV end systolic volume in patients with acute myocardial infarction who received bone marrow therapy versus control.

REVIEW QUESTION AND STUDY PROTOCOL “What is the outcome of bone marrow stem cell transplantation in patients with acute myocardial infarction following percutaneous coronary intervention? This is a protocol-driven systematic review according to Quality of Reporting of Metaanalysis (QUOROM)

INCLUSION CRITERIA  RCTs with comparison of intracoronary stem cell transplantation versus control in patients with acute myocardial infarction  Intention- to- treat analysis  Follow-up ≥ 3 months from therapy EXCLUSION CRITERIA  Use of cytokines for mobilization of BMCs  Irretrievable or unclear data  Treatment of old myocardial infarction (>14 days)  Lack of control group  Duplicate reports  Ongoing or unpublished studies

 PubMed databases ( )  Cochrane Central Registry of Controlled Trials ( )  Clinicaltrials.gov Registry ( )  keywords:  keywords: “stem cells, acute myocardial infarction, randomized controlled trials”

 Study features extracted: outcome definitions. imaging modalities, patient baseline characteristics, and procedural data Primary endpoint: - change in left ventricular ejection fraction (LVEF) from baseline to follow-up Secondary endpoint: - change in left ventricular end systolic volumes

The criteria by Jüni et al

 Dichotomous variables as proportion and percentages.  Continuous variables as mean ± standard deviation or median.  Meta-regression and sensitivity analyses to explore heterogeneity.  Statistical significance for hypothesis testing set at the 0.05, 2-tailed level.

47 Citations Retrieved 16 Complete Articles Assessed Based on Criteria 12 Studies finally included in the systematic review 31 Titles/Abstracts non-relevant used cytokines for BMC mobilization mobilization -2 had MI treatment > 14 days - 1 irretrievable data REVIEW PROCESS

Characteristics of Studies Included in the Meta-analysis N = 934

Range of patients: Follow-up Duration Range: 3-18 months Average Timing of Cell Transplantation after PCI : 1-18 days # of Stem cell Use: 24.6±9.4x10 6 cells Characteristics of Studies Included in the Meta-analysis

Quality of Assessment Scale for Randomized Controlled Trials Included in the Meta-Analysis

Forrest plot of unadjusted difference in mean (with 95% confidence intervals [CIs]) improvement in left ventricular ejection fraction (LVEF) in patients treated with bone marrow–derived cells (BMCs) compared with controls Increase in LVEF of.72% p value <

Forrest plot of unadjusted difference in mean (with 95% confidence intervals [CIs]) improvement in left ventricular end systolic volume (LVESV) in patients treated with bone marrow–derived cells (BMCs) compared with controls Standard Mean Difference Decrease in LVESV of mL p value <

Intracoronary bone marrow stem cell resulted in:  modest yet significant increase in LV ejection fraction  significant decrease in LV end systolic volume ….in patients with acute myocardial infarction ….in patients with acute myocardial infarction