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G-CSF in patients suffering from late revascularized ST elevation myocardial infarction: analysis on the timing of
Markus G Engelmann1, Hans D Theiss, Christine Theiss
1Medical Department I-Cardiology, Ludwig Maximilians University, Klinikum Grosshadern, Munich, Germany. markus.engelmann@med.uni-muenchen.de
Insights
Early administration of granulocyte colony-stimulating factor (G-CSF) improved myocardial perfusion after myocardial infarction. However, G-CSF timing did not affect overall myocardial function in this study.
Area of Science:
- Cardiology
- Regenerative Medicine
- Biomedical Engineering
Background:
- Granulocyte colony-stimulating factor (G-CSF) has shown potential in improving myocardial function post-infarction.
- Previous clinical studies yielded inconclusive results, suggesting treatment timing may be critical.
- This study investigates the impact of G-CSF administration timing on myocardial outcomes.
Purpose of the Study:
- To determine the influence of early versus late G-CSF treatment on myocardial function and perfusion after myocardial infarction.
- To analyze subgroup data from the G-CSF-ST Elevation Myocardial Infarction trial.
Main Methods:
- A subgroup of 44 patients with late revascularized myocardial infarction received G-CSF or placebo for 5 days post-percutaneous coronary intervention (PCI).
- G-CSF was administered either early (within 24 hours) or late (>24 hours) after PCI.
- Magnetic resonance imaging assessed global and regional myocardial function and perfusion at baseline and 3 months.
Main Results:
- G-CSF was safe regardless of early or late administration.
- Early G-CSF treatment significantly improved resting myocardial perfusion compared to placebo (p=0.03).
- No significant difference in global or regional myocardial function was observed based on G-CSF timing.
Conclusions:
- Early G-CSF administration post-myocardial infarction enhances myocardial perfusion but not function.
- Further research is needed on alternative G-CSF dosing or combination therapies to improve cell mobilization and homing.
Objective:
Granulocyte colony-stimulating factor (G-CSF) improves myocardial function after infarction in vivo. Placebo-controlled clinical studies failed to show beneficial effects on myocardial function. Recent data demonstrate that the time point of treatment initiation may be crucial for the efficacy of G-CSF. We investigated the influence of the timing of G-CSF treatment on myocardial function and perfusion in a subgroup study of the G-CSF-ST Elevation Myocardial Infarction trial.
Materials And Methods:
Patients with late revascularized myocardial infarction (n = 44) were treated with either G-CSF or placebo over 5 days after successful percutaneous coronary intervention (PCI). Of the G-CSF group, 13 patients had received G-CSF early treatment started within 24 hours after PCI (mean: 16 +/- 6 hours). In 10 patients, G-CSF was initiated late (>24 hours after PCI, mean: 49 +/- 26 hours). Global and regional myocardial function and perfusion were assessed from baseline to 3 months after PCI using magnetic resonance imaging in 37 patients who completed magnetic resonance follow-up.
Results:
G-CSF was safe when used early or late after PCI. Early G-CSF administration resulted in significantly improved perfusion at rest 1 month after PCI when compared to placebo (Up-slope, signal intensity 1.2 [0.4-1.8] vs 0.6 [0.1-1.3], p = 0.03). Timing of G-CSF had no influence on global and regional function.
Conclusion:
This post-hoc analysis indicates that timing of G-CSF after myocardial infarction does not improve myocardial function but myocardial perfusion if the cytokine is given early. This urges the need to investigate alternative dosage regimens or combination with novel therapeutics promoting mobilization and homing.
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