The SPECT Clinical Study Of Autologous Peripheral Blood Stem Cell Transplantation By Intracoronory Infusion In Patients With Acute Myocardial Infarction (AMI)

Objective:In this study,We evaluated the changing of cardiac function and cardiocyte perfusion of autologous peripheral blood stem cell by G-CSF in patients with AMI,by observing the effect of autologous peripheral blood stem cell (PBSC) transplantation via intracoronory in patients with acute myocardial infarction (AMI) by SPECT.Method:Patient Selection:There were 76 patients with AMI in this study.The study was consented by Liaoning Provincial Hospital Ethics Commette before it performed.Each patient should be consented before he attended the study.Patients below 75 years of age were eligible for inclusion into this study if they had a first AMI during 7 days that was diagnosed as AMI and was treated by coronary stenting where the culprit lesion of the infarct-related artery. The following exclusion criterias were required for patient enrollment: (1) difficulty in obtaining vascular access for percutaneous procedures or ineligibility for percutaneous revascularization; (2) a history of tumor or disease affecting survival in short time;(3) age≥75;(4)anemia and the presence of coagulation dysfunction;(5)active infection;(6)bone tissue with abnormal radiological aspect;(7)primary hemolysis; (8) the presence of cardiogenic shock;(9) any condition that, in the judgment of the investigator ,would place the patient at undue risk.All patients were placed on maximally tolerated medicaltherapy at the time of enrollment.Research Equipment:America Baxter CS 3000 PLUS blood cell separatorAmerica BD FACS Calibur Flow Cytometry mechinePHILIP Integris Allura Xper Fd10 DSATOSHIBA 7100AU/I single photon emission computed tomographyMethod and Observed:76 patients with AMI were randomly allocated to two groups,which were standard medicine therapy group and coronary artery interventional therapy groups (being treated by coronary stenting where the culprit lesion of infarct-related artery), One was PBSC transplantation group (n=35) that received standard drug,coronary artery intervention therapy and intracoronory transfer of PBSC,the other was control group (n=41) that received standard drug and coronary artery intervention therapy.The PBSC transplantation group received Granulocyte Colony- Stimulating Factor (G-CSF:Filgrastim,300μg) with the dose of 300μg /day to mobilize the stem cell, the period was 5 days.On the sixth day,PBSCs were achieved by Baxter CS 3000 blood cell separator into suspend liquid 57ml.On the day,patients were taken to the cardiac catheterization laboratory.PBSC were infused into the infarct related artery (IRA) through over-the-wire balloon center lumen when the balloon was inflated.Cells were infused via the center of an over-the-wire balloon catheter advanced into the stent previously implanted during the acute reperfusion procedure and inflated with low pressure to completely block blood flow for 3 minutes to allow to adhesion and potential transmigration of the infused cells through the endothelium. The volume of infusion PBSC suspend suspension was 5-10mL each time, interrupted by 3 minutes of reflow by deflating the balloon to minimize extensive ischemia.We assessed the 1/3Ejection Fraction,1/3Fulls Fractin,Ejection Fraction and cardiocyte perfuse score with Single PhotonEmission Computed Tomography (TOSHIBA 7100AU/I,Japane) before the transplantation of PBSC and had a follow up 6 months later.Statistical Analysis:Continuous variables were presented as mean±SD.Statistical comparisonswithin the treatment group were made by paired Student's t Test. Differences in variables of two groups were assessed by Independent Sample t Test.Categoric variables were compared with the use of the x2 test. SPSS 13.0 statistics software was adopted. Cardiocyte perfuse score were measured and verified by two experienced observers. A value of P<0.05 was considered statistically significant.Results:6 months follow up later, in the treated group,the differences of 1/3Ejection Fraction were Statistical different [1/3EF(14.89±6.04)%vs(16.88±5.18)%, P= 0.040]; the differences of 1/3Fulls Fractin were not Statistical different [1/3FF(24.63±11.98)%vs(26.40±9.17)%,P=0.516]; but the differences of Ejection Fraction were also Statistical different [EF (45.07±14.56) % vs(49.71±11.2)%,P=0.040].In control group, befor and after 6-month follow-up, 1/3EF, 1/3FF and EF were all not Statistical different(P=0.666,0.932,0.529).[1/3EF(14.91±4.07)%vs(15.40±4.8)%, P= 0.666],[1/3FF(24.22±8.81)%vs(24.34±7.1)%,P=0.932],[EF (44.6±11.69) % vs(45.91±9.54)%,P=0.529].Between two groups underwent 6-month follow-up, 1/3EF[(16.88±5.18)% vs( 15.40±4.8) %],1/3FF[( 26.40±9.17) % vs( 24.34±7.1) % ]and EF[( 49.71±11.2)% vs (45.91±9.54) %]have a litter improve, but not Statistical different(P=0.349,0.429,0.251).In treated group,before and after 6-month follow-up,Cardiocyte perfuse score were Statistical different[1.90vs1.47, P=0.025].In control group, there were not Statistical different[1.95vs1.80,P=0.481].Between two groups underwent 6-month follow-up,treated group have a bit of improve,but not Statistical difference [1.47vs1.80,P=0.096].Conclusion:We concluded that SPECT was a safe, noninvasive and simple method. By SPECT, it has been demonstrated that PBSC transplantation by intracoronary infusion in patients with AMI could improve cardiac function during 6 months follow-up.