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摘要Background Several cell-based therapies for the adjunctive treatment of acute myocardial infarction (AMI) have been investigated in multiple clinical trials, but the benefits still remain controversial. This meta-analysis aims to evaluate the safety and efficacy of bone marrow-derived stem cells (BMC) therapy in AMI patients, but also explores the effect of newer generations of stem cells.<br>　　Methods A systematic literature review and meta-analysis was carried out following the PRISMA guideline. We selected eligible studies from databases including PubMed, EMBASE, the Cochrane Center Register of Controlled Trials, Medline, Clinicaltrials.gov according to the predefined PICOS (population, intervention or treatment, comparison, outcome, and study design) criteria, and extracted information on study characteristics using structured forms. A random-effects meta-analysis was performed on randomized controlled trials (RCT) investigating the effects of bone marrow stem cell therapy in patients with AMI that were published between January 2006 and December 2020. The defined endpoints were all-cause mortality, major adverse cardiac events (MACE) rates, reinfarction, revascularization, left ventricular ejection fraction (LVEF), left ventricular end-systolic and end-diastolic volumes (LVESV/LVEDV). Several subgroup analyses were also performed on bone marrow cell (BMC) trials.<br>　　Results Thirteen RCTS with a total of 1142 participants (591 cell therapy, 551 controls) were eligible for inclusion in meta-analysis. Combining results of 13 RCTs, overall LVEF did not show any significant improvement (1.62%;95%CI,-0.12 to 3.36, P=0.07) in the BMC group as compared to controls, although it resulted in a reduction of LVESV (-4.92ml;95%CI,-7.13 to-2.71, Plt;0.0001). Moreover, BMC treatment was safe and did not lead to any significant increase in MACE rates following BMC infusion as compared to Control, after median follow-up duration of 6-12 months (RR 0.87;95%CI, 0.67 to 1.12). Cell treatment was not associated with any changes in the risk of all-cause mortality between the two groups (8/415 versus 10/408;RR 0.76, 95% CI 0.31 to 1.88; 823 participants) at long-term follow-up. Meta-analyses of LVEF measured by echocardiography, single photon emission computed tomography and cardiac MRI showed evidence of differences in mean LVEF between treatment groups; although the mean differences ranged between 1.5% and 5%, which are accepted to be clinically irrelevant in determining the efficacy of BMCs over standard or control therapy. Results were robust to the risk of selection, performance, and attrition bias from individual studies.<br>　　Conclusion This systematic review and meta-analysis found that intracoronary infusion of BMC with bone marrow-derived stem/progenitor cells is a safe treatment, as the MACE rates and mortality rates were similar between BMC group and control group. There was no significant improvement in left ventricular ejection fraction over short- and long-term follow-up between the two groups;the only significant effect of BMC treatment was the reduction in LVESV in the treatment group as compared to control group. These findings should be interpreted with caution, as event rates were generally low in both groups, leading to a lack of precision. New andamp;nbsp;possibly more potent stem cells are emerging in the field, but their clinical efficacy still needs to be defined in future trials.