Intracoronary ALLogeneic Heart STem Cells to Achieve Myocardial Regeneration - ALLSTAR
Contribution To Literature:
The ALLSTAR trial failed to show reduction in infarct size from intracoronary injection of stem cells after myocardial infarction.
Description:
The goal of the trial was to evaluate treatment with intracoronary allogeneic stem cells compared with placebo among patients with prior myocardial infarction.
Study Design
- Randomized
- Parallel
- Placebo
- Blinded
Patients with prior myocardial infarction were randomized to intracoronary allogeneic cardiosphere-derived stem cells (n = 90) versus placebo (n = 44).
- Total number of enrollees: 142
- Duration of follow-up: 12 months
- Mean patient age: 55 years
- Percentage female: 16%
- Percentage with diabetes: 26%
- Mean left ventricular ejection fraction (LVEF): 40%
Inclusion criteria:
- ≥18 years
- Prior myocardial infarction in the last 12 months
- Successful percutaneous coronary intervention of the infarct-related artery
- LVEF ≤45%
- LV infarct size ≥15% of LV mass
- No further revascularization needed
Exclusion criteria:
- Prior coronary artery bypass grafting
- Acute coronary syndrome within prior 4 weeks
- Previous stem cell therapy
- Prior implantable cardioverter-defibrillator or pacemaker that is not magnetic resonance imaging compatible
- Estimated glomerular filtration rate <30 cc/min
- Current alcohol or drug abuse
Principal Findings:
The primary outcome, percentage change from baseline in infarct size, was similar between groups at 6 months (p = 0.63) and 12 months (p = 0.39).
Secondary outcomes:
- LV volumes: Similar between groups (p = not significant)
- Major adverse cardiac events: 7.8% for stem cell group vs. 11.4% for placebo group (p = 0.49)
Interpretation:
Among patients with prior myocardial infarction, intracoronary injection of allogeneic cardiosphere-derived stem cells was not effective. Intracoronary stem cells did not reduce infarct size or improve LV volumes. Clinical events were similar between the groups.
References:
Presented by Dr. Timothy D. Henry at the American Heart Association Annual Scientific Sessions (AHA 2017), Anaheim, CA, November 15, 2017.
Keywords: Acute Coronary Syndrome, AHA17, AHA Annual Scientific Sessions, Heart Failure, Myocardial Infarction, Percutaneous Coronary Intervention, Primary Prevention, Regeneration, Stem Cells, Treatment Outcome
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