The selection criteria for bone marrow stem cell (BMSC) therapy are not well established for ST segment elevation myocardial infarction (STEMI) patients. This investigation seeks to utilize total ischemic time (TIT), time of symptom onset to percutaneous coronary intervention (PCI), as a criterion for giving BMSC to STEMI patients. A meta-analysis and metaregression were conducted to evaluate improvement of LVEF with BMSC and its association with TIT (<6 and ≥6 hours) and baseline LVEF (<45% and ≥45%) at short (3–6 months) and long term (>6 months) followup. At short term, BMSC allowed improvement of LVEF with prolonged TIT (6.62%, 95% CI, 2.26 to 10.98 for <45%; 6.13%, 95% CI, 2.59 to 9.67 for ≥45%). Similarly, for long term, receiving BMSC allowed significant improvement of LVEF for prolonged TIT (9.19%, 95% CI, 2.34 to 16.05 for <45%; 7.64%, 95% CI, 3.72 to 11.56 for ≥45%). Additionally, TIT was a significant predictor of LVEF improvement independent of baseline LVEF in both short (4.96%, 95% CI, 0.72 to 9.19, P=0.02) and long term (6.24%, 95% CI, 0.46 to 12.02, P=0.03) followup. Consequently, BMSC therapy allows LVEF improvement in prolonged TIT and future studies for BMSC should include TIT ≥ 6 hours as an inclusion criterion.

Background: Sudden cardiac death (SCD) is a major cause of mortality in the United States, and in-hospital mortality for successfully resuscitated patients remains high. Our hospital is a level one cardiovascular center in a major metropolitan area and receives the majority of SCD patients in the region. The purpose of this study was to evaluate whether SCD patients who undergo cardiac catheterization demonstrated significantly improved survival or neurological outcomes. Methods: 205 consecutive SCD patients admitted to our hospital from 2004 –2007 were evaluated. Using Chi-squared univariate analyses, we compared patients that underwent cardiac catheterization versus those that did not. We also performed a subanalysis comparing patients that underwent cardiac catheterization within three hours of hospital arrival versus those that underwent cardiac catheterization after the initial three-hour period. Primary endpoints included survival and neurological outcome (using the previously validated CPC score). ...