Salvatore De Rosa, Division of Cardiology, Department of Medicine III, Goethe University Frankfurt, Germany, and others reported in Circulation: Cardiovascular Interventions that intracoronary administration of progenitor cells is associated with an adequate safety profile in patients with acute myocardial infarction or chronic heart failure.
De Rosa et al commented that some studies have shown that intracoronary infusion of autologous bone marrow-derived mononuclear cells (BM-MNC) is associated with contractile recovery of left ventricular function. However, they added that as the procedure requires the use of intracoronary instrumentation, there may a risk of complications—they explained: “It is well-established that even in elective uncomplicated cardiac or coronary procedures, almost one-third of patients experience some increase in troponin.” The aim of De Rosa et al’s study, therefore, was to assess the procedural safety of intracoronary administration of progenitor cells with the stop-flow technique.
Of a cohort of 775 consecutive patients who underwent intracoronary administration of progenitor cells between January 2001 and April 2010 (at the authors’ centre), 126 had acute myocardial infarction, 562 had chronic heart failure of ischaemic aetiology, and 87 had chronic heart failure of non-ischaemic aetiology. In the majority of patients (637), BM-MNCs were isolated from bone marrow aspirate (taken from the iliac crest) through density gradient centrifugation. However for the remaining 138 patients, progenitor cells were isolated from peripheral blood via density gradient centrifugation.
De Rosa et al reported that for the intracoronary administration procedure, “An over-the-wire balloon catheter oversized by 0.5mm was advanced into the proximal target vessel. To allow for adhesion and potential transmigration of the infused cells, the stop-flow technique was applied.” They added that the cells were administered into a native coronary artery for 638 procedures, administered through a bypass graft in 107 procedures, and injected into the vessel supplying collateral perfusion of the target area (because of chronic occlusion of the vessel perfusing the target region) in the remaining 28 procedures.
The authors commented: “Intracoronary infusion of cells was associated with coronary complications in 11 of 755 procedures (1.9%), consisting of two flow-limiting dissections (0.3%) with occlusion of either a main epidcardial vessel or a side branch, seven non-flow limiting dissections (0.9%), and two procedures with angiographic evidence of thrombus formation (0.3%).” They added that cells infused into a bypass graft were associated with a greater procedural risk compared cells infused into a native coronary artery in the cohort of patients with ischaemic chronic heart failure (2.8% risk vs. 1.8% risk, respectively). De Rosa et al wrote: “Importantly, all coronary complications were observed in patients with acute or chronic ischaemic heart disease. No complications were observed in patients with non-ischaemic chronic heart failure. No intraprocedural deaths occurred.”
Concluding, the authors commented: “The current single-centre analysis demonstrates that intracoronary administration of progenitor cells with the stop-flow technique can be performed with adequate safety in patients with acute myocardial infarction as well as in patients with chronic heart failure.”