Repeated Intramyocardial Bone Marrow Cell Injection in Previously Responding Patients With Refractory Angina Again Improves Myocardial Perfusion, Anginal Complaints, and Quality of Life

Background Intramyocardial bone marrow cell injection is associated with improvements in myocardial perfusion and anginal symptoms in patients with refractory angina pectoris. This study evaluates the effect of repeated intramyocardial bone marrow cell injection in patients with residual or recurrent myocardial ischemia. Methods and Results Twenty-three patients (17 men; 699 years) who had improved myocardial perfusion after the first injection but had residual or recurrent angina and ischemia on single-photon emission computed tomographic myocardial perfusion imaging were included. Patients again received intramyocardial injection of 100x10(6) autologous bone marrow mononuclear cells, 4.62.5 years after their first injection. No periprocedural complications occurred. Myocardial perfusion assessed using single-photon emission computed tomographic myocardial perfusion imaging improved from a summed stress score of 27.3 +/- 5.8 at baseline to 24.5 +/- 4.4 at 3 months (P=0.002) and 25.4 +/- 4.9 at 12 months of follow-up (P=0.002). Perfusion improvement after 3 months was comparable with the effect of the first injection (P=0.379). Anginal complaints improved 12 months after cell injection in Canadian Cardiovascular Society score (mean change at 3, 6, and 12 months: 0.6 +/- 0.9%, 0.5 +/- 0.9%, and 0.6 +/- 0.9%, respectively; P-slope=0.007, first versus repeated; P=0.188) and in quality of life score as measured by Seattle Angina Questionnaire (mean change at 3, 6, and 12 months: 7 +/- 14%, 8 +/- 14%, and 7 +/- 15%, respectively; P-slope=0.020, first versus repeated; P=0.126). Conclusions Repeated bone marrow cell injection in previously responding patients with refractory angina is associated with improvements in myocardial perfusion, anginal complaints, and quality of life score 12 months of follow-up. Clinical Trial Registration URL: http://www.trialregister.nl. Unique identifier: NTR2664.