Rational Route of Delivery Mesenchymal Stem Cell Therapy for Acute Myocardial Infarction (AMI) and Chronic Ischemic Cardiomyopathy (ICM): a Systematic Review and Meta-analysis

Abstract Background: Recent studies suggest that mesenchymal stem cells (MSCs) may have therapeutic potential for both acute myocardial infarction (AMI) and chronic ischemic cardiomyopathy (ICM). However, the rational route of delivery MSC therapy has not reached consensus. We performed a systematic review of clinical trials evaluating the rational route of delivery MSCs for AMI or ICM.Methods: Databases including Embase, PubMed, and Cochrane Central Register of Controlled Trials were searched from inception to February 2021. Studies that examined the use of MSCs in adults with AMI or ICM were eligible. Bias of included studies were assessed by the Cochrane risk of bias tool. The primary outcome was cardiac function assessed by left ventricular ejection fraction (LVEF) and the secondary outcome was cardiac remodeling which was assessed by left ventricular end-systolic volume (LVESV) and left ventricular end-diastolic volume (LVEDV), we also explored the safety between different routes. Results: 18 studies fulfilled eligibility criteria, which consist of 11 studies evaluated AMI and 7 studies evaluated ICM. In AMI group, only when patients received intracoronary infusion(IC) can improve LVEF (SMD 0.88, 95% CI 0.64-1.12), and there was a decrease in LVEDV&LVESV when administered IC or intravenous infusion (IV). While in ICM group, no significant difference in LVEF was noted no matter administered which route, and transendocardial stem cell injection(TESI) seems to be effective in decreasing LVEDV&LVESV. Safety appeared no difference between different routes. Conclusions: Results from our systematic review suggest that intracoronary infusion seems more effective for MSC’s delivery in AMI group, while in ICM group, TESI better.