Hemostasis and Stem Cell Therapy in Myocardial Infarction

Cardiovascular disease has been well known as the most frequent cause of death in many countries all over the world.1 Acute myocardial infarction (AMI) is a sudden clinical coronary event that has high mortality and morbidity rate. The survivals of AMI will have left ventricle (LV) remodelling and decreased cardiac functions in the following years due to necrosis of cardiomyocites after AMI leading to chronic heart failure. However, revascularization therapy such as percutaneous coronary intervention (PCI) and medications cannot regenerate the necrotic cardiomyocites. Stem cell (SC) therapy as novel strategy in management of AMI has been developing so fast recently. Potential beneficial mechanism of SC therapy after AMI includes myocardial preservation, decreased infarct expansion and myocardial regeneration.2 To date, SC therapy in management of AMI seemed feasible and safe in clinical practice. Number of trials had been conducted to search for promising results and answers to many questions regarding the matter. The TOPCARE-AMI (transplantation of progenitor cells and regeneration enhancement in acute myocardial infarction) with 59 patients showed improvement in ejection fraction and infarct size after 1 year follow-up. The REPAIR-AMI (reinfusion of enriched progenitor cells and infarct remodelling in acute myocardial infarction) trial with larger samples of 204 patients showed improvement in global LVEF at 4 months follow up from 48.3%±9.2% to 53.8%±10.2%.6 A systematic review of SC therapy in AMI with 13 RCT and 811 enrolled patients indicated LV function improvement in short term follow-up