Acute Myocardial Infarction
Conditions
Keywords
Heart attack, Anterior Myocardial infarction (MI), adult stem cells, bone marrow progenitor cells, bone marrow stem cells, autologous, left ventricular function, intracoronary injection
Brief summary
Study hypothesis : The purpose of this study is to determine whether Intracoronary infusion of autologous bone marrow derived progenitor cells to patients undergoing primary angioplasty for acute anterior myocardial infarction will lead to an improvement in cardiac function greater than that seen by placebo alone. Aims * To demonstrate that it is safe and feasible to deliver autologous bone marrow derived stem cells within hours of the primary angioplasty procedure * To demonstrate the effects of autologous bone marrow derived stem cells on cardiac function using cardiac MRI (or cardiac CT), echocardiography and left ventriculography. * To demonstrate the effect of autologous bone marrow derived stem cells in addition to standard care leads to improvement in cardiac function compared to patients saline(placebo) and standard care.
Interventions
OTHERBone marrow derived progenitor cells or placebo infusion
Over-the-wire balloon catheter delivers infusion into coronary vessel using a stop-flow technique
OTHERPlacebo infusion
Placebo infusion
Sponsors
Barts & The London NHS Trust
University College, London
Queen Mary University of London
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Patients presenting to the Heart Attack Centre with acute anterior myocardial infarction (ST elevation in at least 2 contiguous anterior leads ≥ 0.2 mV) and treated with acute PCI with stent implantation within 24 hours after symptom onset * Acute PCI / stent implantation has been successful (residual stenosis visually \< 30% and TIMI flow ≥ 2). * At the time of inclusion patient no longer requires i.v. catecholamines or mechanical hemodynamic support (aortic balloon pump) * Significant regional wall motion abnormality in LV angiogram at the time of acute PCI in the LAD territory * Age 18 - 80 Years (primary angioplasty confers an adverse prognosis in those over the age of 80 years) * Written informed consent in the recruiting centres native language
Exclusion criteria
* Regional wall motion abnormality outside the area involved in the index acute myocardial infarction * Need to revascularise additional vessels, outside the infarct artery as a planned procedure (these vessels can be treated at baseline) * Arteriovenous malformations or aneurysms * Active infection, or fever or diarrhoea within last 4 weeks * Chronic inflammatory disease * Known HIV infection or active hepatitis * Neoplastic disease without documented remission within the past 5 years * Cerebrovascular insult within 3 months * Impaired renal function (creatinine \> 200mmol) at the time of cell therapy * Significant liver disease (GOT \> 2x upper limit) or spontaneous INR \> 1,5) * Anemia (hemoglobin \< 8.5 mg/dl) * Platelet count \< 100.000/µl * Hypersplenism * Known allergy or intolerance to clopidogrel, heparin or abciximab * History of bleeding disorder * Gastrointestinal bleeding within 3 months * Major surgical procedure or trauma within 2 months * Uncontrolled hypertension * Pregnancy * Mental retardation leading to inability to obtain informed consent * Previously performed stem / progenitor cell therapy * Participation in another clinical trial within the last 30 days
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Longitudinal change in left ventricular function (ejection fraction) | 1 year |
Secondary
| Measure | Time frame |
|---|---|
| Longitudinal change in left ventricular function as measured by LV angiography | 6 months |
| Longitudinal change in left ventricular function assessed by echocardiography. | 6 months |
| Longitudinal change in left ventricular function (ejection fraction), change in left ventricular end systolic volume, and change in infarct size | 3 months |
| MACE | 12 months |
| Change in Quality of life | 6 and 12 months |
| Change in left ventricular end systolic volume and change in infarct size. | 12 months |
Countries
Denmark, Switzerland, United Kingdom
Outcome results
None listed