Autologous CD34(+) cell therapy improves exercise capacity, angina frequency and reduces mortality in no-option refractory angina: a patient-level pooled analysis of randomized double-blinded trials Article

Full Text via DOI: 10.1093/eurheartj/ehx764 PMID: 29315376 Web of Science: 000435467200019
International Collaboration

Cited authors

  • Henry, Timothy D.; Losordo, Douglas W.; Traverse, Jay H.; Schatz, Richard A.; Jolicoeur, E. Marc; Schaer, Gary L.; Clare, Robert; Chiswell, Karen; White, Christopher J.; Fortuin, F. David; Kereiakes, Dean J.; Zeiher, Andreas M.; Sherman, Warren; Hunt, Andrea S.; Povsic, Thomas J.

Abstract

  • Aims Autologous CD34(+) (auto-CD34(+)) cells represent an attractive option for the treatment of refractory angina. Three double-blinded randomized trials (n = 304) compared intramyocardial (IM) auto-CD34(+) with IM placebo injections to affect total exercise time (TET), angina frequency (AF), and major adverse cardiac events (MACE). Patient-level data were pooled from the Phase I, Phase II ACT-34, ACT-34 extension, and Phase III RENEW trials to determine the efficacy and safety of auto-CD34(+) cells.; Methods and results Treatment effects for TET were analysed using an analysis of covariance mixed-effects model and for AF using Poisson regression in a log linear model with repeated measures. The Kaplan-Meier rate estimates for MACE were compared using the log-rank test. Autologous CD34(+) cell therapy improved TET by 46.6 s [3 months, 95% confidence interval (CI) 13.0 s-80.3 s; P = 0.007], 49.5 s (6 months, 95% CI 9.3-89.7; P = 0.016), and 44.7 s (12 months, 95% CI -2.7 s-92.1 s; P = 0.065). The relative frequency of angina was 0.78 (95% CI 0.63-0.98; P = 0.032), 0.66 (0.48-0.91; P = 0.012), and 0.58 (0.38-0.88; P = 0.011) at 3-, 6- and 12-months in auto-CD34(+) compared with placebo patients. Results remained concordant when analysed by treatment received and when confined to the Phase III dose of 1 x 10(5) cells/kg. Autologous CD34(+) cell therapy significantly decreased mortality (12.1% vs. 2.5%; P = 0.0025) and numerically reduced MACE (38.9% vs. 30.0; P = 0.14) at 24 months.; Conclusion Treatment with auto-CD34(+) cells resulted in clinically meaningful durable improvements in TET and AF at 3-, 6- and 12-months, as well as a reduction in 24-month mortality in this patient-level meta-analysis.

Authors

Publication date

  • 2018

Published in

International Standard Serial Number (ISSN)

  • 0195-668X

Start page

  • 2208

End page

  • 2216

Volume

  • 39

Issue

  • 23