Comment: The first purely academic, phase III, multinational and randomized clinical trial to analyse the clinical effect of first generation autologous bone marrow-derived mononuclear stem cells in STEMI patients was presented last month during the ESC Congress and simultaneously published in the European Heart Journal. Very much anticipated, this trial was hampered by under recruitment (375 randomized patients out of 3000 planned originally). Therefore, no definitive conclusions can be drawn on the effect of those cells on all-cause mortality in STEMI but and safety has been established once again. Nevertheless, the trial demonstrated that autologous cell-based therapies can be administered in multiple sites across Europe in a harmonized way and with standardized manufacturing protocols. Furthermore, the very low contemporary mortality rates of STEMI at two years (3.5% and not 12% as designed) pointed out the difficulties of future clinical trials of cell-based (or other) therapies aimed at improving the prognosis of patients suffering from STEMI.