Clin Res Cardiol 100, Suppl 1, April 2011

P1676 - Procedural safety and predictors of acute outcome of intracoronary administration of progenitor cells in 775 consecutive procedures performed for acute myocardial infarction or chronic heart failure
 
S. De Rosa1, F. Seeger1, J. Honold1, U. Fischer-Rasokat1, R. Lehmann1, S. Fichtlscherer1, V. Schächinger2, S. Dimmeler3, A. M. Zeiher1, B. Aßmus1
 
1Zentrum Innere Medizin III, Schwerpunkt Kardiologie, Universitätsklinikum Frankfurt am Main, Frankfurt am Main; 2Medizinische Klinik I, Klinikum Fulda gAG, Fulda; 3Zentrum für Molekulare Medizin, Goethe Universität, Institut für Kardiovaskuläre Regeneration, Frankfurt am Main;
 
Cell based therapies are a promising option in patients with acute myocardial infarction (AMI) or chronic heart failure (CHF). However, administration of cells requires intracoronary or intra-cardiac instrumentation, which is potentially associated with peri-procedural risks. We, therefore, analyzed periprocedural complications and 30-day outcome in 775 consecutive procedures of intracoronary administration of  bone marrow-derived mononuclear cells (BMC) using the stop-flow technique.
Indications for BMC administration were AMI (n=126) and CHF of ischemic (n = 562) or non-ischemic (n = 87) etiology.
Bone marrow puncture was performed under local anesthesia and was well tolerated. No pronounced haematoma formation or bleeding at the bone marrow puncture site were observed. Vascular access for BMC administration was the femoral artery in 719 procedures and the radial artery in 56 procedures. There were 2 major complications (0.2%) related to the access site and consisting in a large tight hematoma with retroperitoneal effusion, which successfully treated with prolonged manual compression; and one thrombotic occlusion of the radial artery several days after the procedure, which was successfully managed by means of fogarty thrombectomy.
Concomitant PCI was performed during 153 (19.7%) procedures, including PCI of the target vessel for cell administration in 113 procedures (14.6%), and PCI on a different vessel in 55 cases (7.1%).
Cardiac arrhythmias starting during the cell administration procedure were observed in a total of 6 procedures (0.8%), consisting in atrial flutter (n=1); ventricular fibrillation during ischemia induction by balloon occlusion (n=2 procedures but in the same patient); non-sustained ventricular tachycardia (n=2); and reversible left bundle-branch block (n=1).
Coronary vessel injury was observed in a total of 8 procedures (1%), consisting in flow-limiting dissection (n=2), non flow-limiting dissection (n=4), thromboembolic event (n=1). All vessel injuries could be promptly managed by additional PCI. No procedural deaths were observed. A periprocedural increase in troponin T was observed in 3.2% of the CHF procedures, in which no concomitant PCI was performed and troponin levels were below the detection limit prior to the procedure. Independent significant predictors of troponin T increase were periprocedural vessel injury (p=0.042), concomitant revascularization (p<0.001) , a higher NYHA class (p=0.001), and elevated troponin T already prior to the procedure (p<0.001).
Event rate at 30-days was very low, with 4 deaths (0.5%), 1 stroke (0.13%), 8 AMI (1%) and 5 hospitalizations for exacerbation of heart failure (0.64%).
In conclusion, intracoronary infusion of BMC can be performed with adequate safety in patients with acute myocardial infarction or chronic heart failure.
 
Clin Res Cardiol 100, Suppl 1, April 2011
Zitierung mit Vortrags- oder Posternummer s.o.
DOI 10.1007/s00392-011-1100-y

http://www.abstractserver.de/dgk2011/ft/abstracts/P1676.htm