Cell Therapy in Myocardial Infarction (EMRTCC)

Inclusion Criteria:

• Patients will be eligible if presenting all characteristics described below:

  • ST segment elevation myocardial infarction, according to the WHO definition (two from the following three):

    i) Presence of chest pain. ii) Presence of ST segment elevation in two or more contiguous leads. iii) Elevation of the myonecrosis markers.

  • Age between 30 and 80 years old.
  • Invasive ventriculography presenting ejection fraction <50% (Dodge method) and segmentary dysfunction of the infarction area, measured immediately before PCI. Among patients submitted to thrombolytic therapy, the angioplasty of the related artery should be preferably done up to 24h after thrombolysis, with a maximum deadline of 48h after thrombolysis. This recommendation is based on the last Percutaneous Coronary Intervention guideline published by the European Society of Cardiology, in April 2005.68 IA recommendation degree.

Exclusion Criteria:

• Patients will be ineligible if presenting any of the characteristics described below:

  • AMI related artery presenting TIMI < 3 at the moment f cell injection.
  • Left Main Coronary Artery Lesion of >50% or multivessel coronariopathy (>70% lesion in vessels with >2,0mm diameter in left anterior descending, circumflex and right coronary territory) indicating the need for CABG or angioplasty with three or more stents implant.
  • Coronary anatomy, after thrombolytic reperfusion, presenting no need for angioplasty with stent implant.
  • Final Diastolic Pression of the LV higher than 30 mmHg during ventriculography for evaluating EF inclusion criteria for the research protocol (item "c" of inclusion criteria).
  • Cardiac arrest or Killip IV AMI at admission with need of ventilatory support.
  • Cardiogenic shock persisting up to the third day after AMI (with need of Intra-aortic balloon pump or vasopressors).
  • AMI mechanical complications (ventricular septal defect, papillary muscle rupture, and left ventricular free wall rupture).
  • Significant valve disease, defined as aortic stenosis (mean systolic pressure gradient across the aortic valve >50mmHg), mitral stenosis with a valvar area less than 1,5 cm,2 moderate to severe aortic and/or mitral regurgitation.
  • Chronic use of immunosuppressive agents.
  • > 2,0 mg/dl creatinine or previous dialysis treatment.
  • Presence of fever on the past 48h before injection glaring active systemic infection according to ACCP/SCCM (American College of Chest Physicians/Society of Critical Care Medicine) sepsis definition.
  • Sustained ventricular tachycardia 48h after AMI.
  • Illicit drugs abuse or alcohol abuse (based on DSM IV).
  • Any co morbidity, with survival impact in two years.
  • Myocarditis
  • Active liver disease
  • COPD in continuous steroids use.
  • Hematological disease, neoplasm, bone disease or hemostatic disturbances.
  • Inflammatory disease or chronicle infectious disease.
  • Presence of definitive implantation of a cardiac pace maker or cardiac defibrillator.
  • Impossibility to reach a cells suspension of 100 million mononuclear cells due to cells paucity in the bone marrow aspirate.