Safety and efficacy of stem cell therapy in acute myocardial infarction: a systematic review and meta-analysis of adverse events, infarct size and LV ejection fraction assessed by CMRI
Introduction The current standard treatment for ST-segment elevation myocardial infarction is prompt reperfusion through primary percutaneous coronary intervention. However, myocardial infarction remains the leading cause of heart failure, contributing to prolonged hospital stay and a 30% rehospital...
Saved in:
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2025-06-01
|
| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/12/1/e003301.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849433734344867840 |
|---|---|
| author | Dede Moeswir Putri Nurbaeti Hari Hendarto Muhammad Farhan Abdul Rahman |
| author_facet | Dede Moeswir Putri Nurbaeti Hari Hendarto Muhammad Farhan Abdul Rahman |
| author_sort | Dede Moeswir |
| collection | DOAJ |
| description | Introduction The current standard treatment for ST-segment elevation myocardial infarction is prompt reperfusion through primary percutaneous coronary intervention. However, myocardial infarction remains the leading cause of heart failure, contributing to prolonged hospital stay and a 30% rehospitalisation rate within 6 months. Stem cell therapy has emerged as a potential approach to repair myocardial damage.Methods This study is a meta-analysis of randomised clinical trials available online. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the study was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions.Results 21 articles from 15 trials (21 clinical trial interventions) with a total of 1218 participants were included. Stem cell therapy was associated with fewer adverse events than controls (OR 0.66, 95% CI 0.44 to 0.99, p=0.05), supporting its short-term to mid-term safety. No cardiac-related cancer cases were reported in any group, but longer follow-up is needed to assess potential oncogenic risks. Efficacy analyses showed no significant effect on infarct size (absolute or relative) or left ventricular ejection fraction (LVEF) in short-term follow-up. In long-term follow-up, relative infarct size became statistically significant in favour of stem cell therapy only after exclusion of an outlier study (standardised mean difference −0.63, 95% CI −0.94 to −0.32, p<0.0001). Long-term LVEF improvement was also significant (mean difference 2.63%, 95% CI 0.50% to 4.76%, p=0.02), although substantial heterogeneity remained unexplained despite sensitivity analyses, including the removal of low-correlation studies.Conclusion Stem cell therapy for acute myocardial infarction demonstrates a favourable safety profile. While overall efficacy remains uncertain, long-term benefits may exist, particularly for relative infarct size and LVEF. However, interpretation is limited by study heterogeneity. Future trials with standardised protocols and longer follow-up are warranted. |
| format | Article |
| id | doaj-art-e013e6abefb74f4fb3dc68cb2edf854e |
| institution | Kabale University |
| issn | 2053-3624 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj-art-e013e6abefb74f4fb3dc68cb2edf854e2025-08-20T03:26:56ZengBMJ Publishing GroupOpen Heart2053-36242025-06-0112110.1136/openhrt-2025-003301Safety and efficacy of stem cell therapy in acute myocardial infarction: a systematic review and meta-analysis of adverse events, infarct size and LV ejection fraction assessed by CMRIDede Moeswir0Putri Nurbaeti1Hari Hendarto2Muhammad Farhan Abdul Rahman3Division of Cardiology, Department of Internal Medicine, UIN Syarif Hidayatullah, Jakarta, IndonesiaDivision of Cardiology, Department of Internal Medicine, UIN Syarif Hidayatullah, Jakarta, IndonesiaDivision of Endocrine-Metabolic-Disease, Department of Internal Medicine, UIN Syarif Hidayatullah, Jakarta, IndonesiaDivision of Cardiology, Department of Internal Medicine, UIN Syarif Hidayatullah, Jakarta, IndonesiaIntroduction The current standard treatment for ST-segment elevation myocardial infarction is prompt reperfusion through primary percutaneous coronary intervention. However, myocardial infarction remains the leading cause of heart failure, contributing to prolonged hospital stay and a 30% rehospitalisation rate within 6 months. Stem cell therapy has emerged as a potential approach to repair myocardial damage.Methods This study is a meta-analysis of randomised clinical trials available online. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and the study was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions.Results 21 articles from 15 trials (21 clinical trial interventions) with a total of 1218 participants were included. Stem cell therapy was associated with fewer adverse events than controls (OR 0.66, 95% CI 0.44 to 0.99, p=0.05), supporting its short-term to mid-term safety. No cardiac-related cancer cases were reported in any group, but longer follow-up is needed to assess potential oncogenic risks. Efficacy analyses showed no significant effect on infarct size (absolute or relative) or left ventricular ejection fraction (LVEF) in short-term follow-up. In long-term follow-up, relative infarct size became statistically significant in favour of stem cell therapy only after exclusion of an outlier study (standardised mean difference −0.63, 95% CI −0.94 to −0.32, p<0.0001). Long-term LVEF improvement was also significant (mean difference 2.63%, 95% CI 0.50% to 4.76%, p=0.02), although substantial heterogeneity remained unexplained despite sensitivity analyses, including the removal of low-correlation studies.Conclusion Stem cell therapy for acute myocardial infarction demonstrates a favourable safety profile. While overall efficacy remains uncertain, long-term benefits may exist, particularly for relative infarct size and LVEF. However, interpretation is limited by study heterogeneity. Future trials with standardised protocols and longer follow-up are warranted.https://openheart.bmj.com/content/12/1/e003301.full |
| spellingShingle | Dede Moeswir Putri Nurbaeti Hari Hendarto Muhammad Farhan Abdul Rahman Safety and efficacy of stem cell therapy in acute myocardial infarction: a systematic review and meta-analysis of adverse events, infarct size and LV ejection fraction assessed by CMRI Open Heart |
| title | Safety and efficacy of stem cell therapy in acute myocardial infarction: a systematic review and meta-analysis of adverse events, infarct size and LV ejection fraction assessed by CMRI |
| title_full | Safety and efficacy of stem cell therapy in acute myocardial infarction: a systematic review and meta-analysis of adverse events, infarct size and LV ejection fraction assessed by CMRI |
| title_fullStr | Safety and efficacy of stem cell therapy in acute myocardial infarction: a systematic review and meta-analysis of adverse events, infarct size and LV ejection fraction assessed by CMRI |
| title_full_unstemmed | Safety and efficacy of stem cell therapy in acute myocardial infarction: a systematic review and meta-analysis of adverse events, infarct size and LV ejection fraction assessed by CMRI |
| title_short | Safety and efficacy of stem cell therapy in acute myocardial infarction: a systematic review and meta-analysis of adverse events, infarct size and LV ejection fraction assessed by CMRI |
| title_sort | safety and efficacy of stem cell therapy in acute myocardial infarction a systematic review and meta analysis of adverse events infarct size and lv ejection fraction assessed by cmri |
| url | https://openheart.bmj.com/content/12/1/e003301.full |
| work_keys_str_mv | AT dedemoeswir safetyandefficacyofstemcelltherapyinacutemyocardialinfarctionasystematicreviewandmetaanalysisofadverseeventsinfarctsizeandlvejectionfractionassessedbycmri AT putrinurbaeti safetyandefficacyofstemcelltherapyinacutemyocardialinfarctionasystematicreviewandmetaanalysisofadverseeventsinfarctsizeandlvejectionfractionassessedbycmri AT harihendarto safetyandefficacyofstemcelltherapyinacutemyocardialinfarctionasystematicreviewandmetaanalysisofadverseeventsinfarctsizeandlvejectionfractionassessedbycmri AT muhammadfarhanabdulrahman safetyandefficacyofstemcelltherapyinacutemyocardialinfarctionasystematicreviewandmetaanalysisofadverseeventsinfarctsizeandlvejectionfractionassessedbycmri |