Day 2 - ESC

The day was dominated by the first hotline trial results. The one that caught my eye in particular was the STAR-heart study, covered in depth on Heartwire. In summary, in a group of patients with chronic heart failure due to CAD, the intracoronary infusion of bone marrow-derived stem cells had a significant survival benefit maintained out to 5 years. Accompanying this were improvements in ejection fraction and other measures of functional capacity. A similar size control group received no stem cells but identical follow-up.

Although somehow the results of the study were published a few months before this Hotline Session in the European Heart Journal, the presentation here in Stockholm still caused considerable interest on the conference floor.

The mechanism of such a sustained benefit was the topic of much discussion, given a single administration of cells down the infarct-related artery. Also of note was the improvement in electrical stability seen in the treatment group - with an increase in heart rate variability.

One postulated mechanism was that the transplanted cells act as a scaffold for the resident cardiac stem cells, with direct paracrine effects on these cells another possibility.

What do you think of this landmark study? How about the publication embargo being broken by the European Heart Journal?

What about the mechanism of efficacy here?

Do you envisage a primary PCI procedure eventually involving a shot of stem cells down the infarct related artery after successful PCI?

Your answers to these questions, and others, are most welcome!