September 29, 2004
Starkweather, B.S. and Asher Kimchi M.D.
– The one year follow-up results of the Transplantation of
Progenitor Cells And Regeneration Enhancement in Acute
Myocardial Infarction (TOPCARE-AMI) trial show significant
enhancement of functional regeneration in patients who
sustained an acute myocardial infarction.
These one-year results of the trial were published by Volker
Schächinger M.D., et al, in the Journal of the American
College of Cardiology. The TOPCARE-AMI trial investigated
safety, feasibility, and potential effects on parameters of
myocardial function of intracoronary infusion of either
circulating progenitor cells (CPC) or bone marrow-derived
progenitor cells (BPC) in patients with acute myocardial
A total of 59 patients with AMI were randomly assigned to
receive either CPC or BMC into the infarct artery at 4.9 ± 1.5
days after acute myocardial infarction.
Intracoronary progenitor cell application did not incur any
measurable ischemic myocardial damage, but one patient
experienced distal embolization before cell therapy. During
hospital follow-up, one patient in each cell group developed
myocardial infarction; one of these patients died of
cardiogenic shock. No further cardiovascular events, including
ventricular arrhythmias or syncope, occurred during one-year
follow-up. By quantitative LV angiography at four months, LV
ejection fraction significantly increased and end-systolic
volumes significantly decreased, without differences between
the two cell groups. Contrast-enhanced magnetic resonance
imaging after one year revealed an increased ejection
fraction, reduced infarct size, and absence of reactive
hypertrophy, suggesting functional regeneration of the
Intracoronary infusion of progenitor cells (either BMC or CPC)
is safe and feasible in patients after acute myocardial
infarction successfully revascularized by stent implantation.
Both the excellent safety profile and the observed favorable
effects on LV remodeling provide the rationale for larger
randomized double-blind trials.