Chronic Myocardial Ischemia, Left Ventricular Dysfunction, Old Myocardial Infarction
Conditions
Keywords
Old Myocardial Infarction, Stem Cell Therapy, Coronary Artery Bypass Grafting, Coronary Artery Disease
Brief summary
This prospective, randomized, placebo-controlled study was designed to assess the safety, feasibility and efficacy of intramyocardial injection of autologous bone marrow mononuclear cells in patients with severe, chronic ischemic disease scheduled to coronary artery bypass surgery.
Detailed description
Severe ischemic heart disease remains a clinical challenge; many patients have undergone surgical myocardial revascularization procedures, but still remain symptomatic despite optimal medical therapy. Cell therapy with autologous bone marrow-derived cells (BMC) is a novel therapeutic strategy being tested for surgical treatment in patients with severe, chronic ischemic heart disease. This research study is being performed to find out more information about the safety, feasibility, and efficacy of direct intramyocardial injection of autologous BMC on the myocardial perfusion and left ventricular function as an adjunctive therapy (compared to placebo) in patients undergoing coronary artery bypass surgery (CABG). The heart function evaluations will be performed by electrocardiogram, echocardiogram, and cMRI at baseline and during 6 months follow-up. The secondary objective of this study is to assess the effect of intramyocardial injection of autologous BMC on functional class (angina/heart failure), global and cardiovascular mortality, and major adverse cardiac events after undergoing coronary artery bypass surgery.
Interventions
PROCEDUREbone marrow mononuclear cells injection
Participants will receive direct intramyocardial injection of autologous bone marrow mononuclear cells during CABG.
PROCEDUREplacebo intramyocardial injection
Participants will receive between 10 and 15 placebo injections that consist of saline and 5% human serum albumin during CABG.
Sponsors
Chinese PLA General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Caregiver)
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
1. Age between 18 and 75 years. 2. Scheduled to undergo CABG. 3. At least 3 months since last episode of myocardial infarction. 4. Echocardiogram-assessed LVEF between 15 and 40% (Simpson's rule). 5. Abnormal wall motion of at least one segment due to prior myocardial infarction shown by echocardiography or left ventriculography. 6. Abnormal myocardial perfusion in infarcted area by SPECT. 7. Willingness to participate and ability to provide written informed consent.
Exclusion criteria
1. Contraindications to magnetic resonance imaging. 2. Need for urgent or emergent revascularization. 3. Severe valvular heart disease. 4. Confirmed myocardial infarction within 14 days, and/or rising cardiac biomarker proteins (i.e. troponin), and/or worsening ECG changes. 5. Prior cardiac surgery. 6. Stroke within 3 months prior to CABG. 7. Immunosuppressive medication (e.g. prednisone, cyclophosphamide, etanercept, etc.) 8. Severe chronic renal insufficiency (serum creatinine ≥ 200 mmol/dl or need for dialysis), liver disease, (diagnosis of cirrhosis, chronic hepatitis, or elevation of serum transaminases ≥3 times the upper limit of normal), cerebrovascular disease requiring concomitant carotid endarterectomy, peripheral arterial disease (claudication as the primary factor limiting activity), active non-dermatological malignancy requiring on-going treatment, or any other condition that would place the patient at increased risk for complications in the judgment of the attending cardiologist or cardiac surgeon 9. Hemoglobin less than 10g/dL, white blood cell count less than 4,000/mm3, absolute neutrophil count less than 1500/mm3 10. Active infection, with a temperature greater than 37.5°C within 48 hrs prior to surgery and an unexplained white blood cell count in excess of 10,000/mm3 11. Significant cognitive impairment. 12. Any condition associated with a life expectancy of less than 6 months. 13. Participation in other studies. 14. Positive laboratory test results for HIV, HBC, and HCV. 15. Pregnant woman. 16. Inability or unwillingness to provide written informed consent.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| major adverse cardiac events | 6 months | Freedom from Major Adverse Cardiac Event: cardiac death, myocardial infarction, repeat coronary bypass grafting or percutaneous intervention of bypassed artery |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| left ventricular function | 6 months | Globlal function,regional myocardial perfusion and function assessed by magnetic resonance iamge and echocardiogram |
Countries
China
Contacts
Primary ContactChangqing Gao, MD
Backup ContactLin Zhang, MD
Outcome results
None listed