| Background:In the previous clinical trials,several mesenchymal stem cells-based therapies for adjuvant treatment of acute myocardial infarction had been studied.However,their clinical benefits remain still to be controversial.This meta-analysis aims to evaluate the effect of coronary transplantation of mesenchymal stem cells on left ventricular function in patients with acute myocardial infarction.Objective:To systematically evaluate the effect of intracoronary transplantation of mesenchymal stem cells on left ventricular function after primary percutaneous coronary intervention(PPCI)in patients with acute myocardial infarction(AMI),and to provide high-quality evidence for future clinical treatment.Methods:By searching the foreign language databases such as Pubmed,The Cochrane Library and Embase and Chinese databases such as CNKI,VIP database,Wanfang database,the randomized controlled trials related to coronary transplantation of mesenchymal stem cells in the treatment of patients with acute myocardial infarction was searched.The search time ranged from the establishment of the database to October 2020.After two systematic reviewers screened the literature according to the criteria of literature inclusion and exclusion,and extracted the related important information from the data,Rev Man 5.3 software was used to evaluate the bias risk of the included literature,and meta-analysis was carried out.Results:According to the inclusion and exclusion criteria,9 randomized controlled trials(455 patients with acute myocardial infarction)were finally included.Meta-analysis showed that compared with conventional treatment drugs,the left ventricular ejection fraction(LVEF)of patients with acute myocardial infarction after receiving mesenchymal stem cell transplantation was significantly improved(MD=6.12%,95%CI:3.25-9.00,P<0.0001),but there was no statistical difference in preventing and reversing left ventricular remodeling(left ventricular end-diastolic volume(LVEDV)MD=-4.35ml,95%CI,-13.88-5.17%,P=0.37,left ventricular end-systolic volume(LVESV)MD=-4.65ml,95%CI,-12.25-2.94%,P=0.23).Subgroup analysis showed that this benefit lasted for at least 12 months(including3-month MD=8.09%,95%CI,0.44-15.74%,P=0.04;6-month MD=4.08%,95%CI,1.8-6.36%,P=0.0004;12-month MD=2.45%,95%CI,0.79-4.11%,P=0.004).In addition,the clinical benefit was greater for patients with acute myocardial infarction and LVEF<50%(low LVEF baseline group:MD=7.97%,95%CI,1.77-14.17%,P=0.01;high LVEF baseline group:MD=2.71%,95%CI,-0.36-5.77%,P=0.08).When the number of transplanted MSCs was more than 10~7,the improvement of left ventricular ejection fraction was more significant(MD=7.41%,95%CI,1.22-13.59%,P=0.02).Conclusion:Coronary transplantation of mesenchymal stem cells can significantly improve LVEF in patients with acute myocardial infarction.However,in terms of left ventricular remodeling,there is not enough evidence to prove that mesenchymal stem cells can reverse left ventricular remodeling. |
