Widespread Intracoronary Cardiopoietic Cell Infusion

The acute management of ST-segment–elevation myocardial infarction is now primarily focused on rapid restoration of myocardial perfusion to reduce myocardial infarct size, improve systolic function, and attenuate long-term postinfarction left ventricular (LV) remodeling. Indeed, in the contemporary reperfusion era, LV systolic function is now relatively preserved with postinfarction ejection fractions averaging 50%. As a result, postinfarction heart failure after primary coronary intervention now develops in fewer than ≈5% of patients and most have only New York Heart Association functional class I or II symptoms. In addition to early reperfusion, blockade of the neurohormonal axis with pharmacological therapies including angiotensin inhibition, β-blockers, aldosterone antagonists, and now neprilysin inhibitors have significantly improved prognosis. These therapies further limit postinfarction remodeling and variably increase LV systolic function, resulting in improved functional capacity and increased survival. Yet, despite these significant therapeutic successes, a minority of patients go on to develop progressive LV dysfunction as well as recurrent myocardial infarction. This has motivated approaches to regenerate the myocytes and myocardium lost using cardiac cell therapies, which has become the focus of considerable preclinical and clinical investigation during the last 15 years. Although much research has focused on directly injecting cells into the myocardium, intra-arterially infused cardiopoietic stem cell therapies delivered at the time of myocardial reperfusion are emerging as promising candidates to improve LV dysfunction.