Coronary flow reserve is an important measure of the integrity of the coronary microcirculation. Moreover, impaired coronary flow reserve is a predictor of future cardiovascular events and poor prognosis in patients after acute myocardial infarction. After acute myocardial infarction, coronary flow reserve remains significantly reduced. A previous randomized, double-blind Placebo-controlled trial (REPAIR-AMI) demonstrated complete normalization of coronary flow reserve after intracoronary application of autologous bone marrow-derived progenitor cells (but no effect in the placebo group) in patients with ST segment elevation myocardial infarction. The current study is planned to extend these findings to patients with Non-ST segment elevation myocardial infarction, since these patients have an equally reduced outcome.
Improvement of neovascularization is a key mechanism of functional improvement of intracoronary application of progenitor cells after acute myocardial infarction. Since capillary density cannot be assessed histological in patients, measurement of coronary flow reserve is an exact means for estimating capillary density and assessing coronary microvascular function. With the help of an intracoronary Doppler Wire, coronary hemodynamics can be assessed at baseline and, for example, adenosin-induced maximal vasodilation. Calculation of the minimal vascular resistance indices allows to estimate the cross-sectional area, reflecting capillary density, and, in comparison with the time of the acute myocardial infarction, estimation of improved neovascularization at a later timepoint. In order to improve neovascularization, which may then be associated with improved left ventricular contractility, we initiated the current trial.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
31
intracoronary infusion of autologous bone marrow-derived progenitor cells isolated from 50 ml bone marrow aspirate
intracoronary infusion of placebo medium
Med. Klinik III; Kardiologie
Frankfurt, Germany
Universität Leipzig / Herzzentrum
Leipzig, Germany
Improvement of coronary flow reserve in the infarct vessel
Time frame: 4 months
Improvement of relative coronary flow reserve
Time frame: 4 months
Improvement of global and regional left ventricular ejection fraction
Time frame: 4 months
Major adverse cardiac events (death, MI, rehospitalization for heart failure, revascularization)
Time frame: 4 months
Major adverse cardiac events (death, MI, rehospitalization for heart failure, revascularization)
Time frame: 12 months
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