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Myocardial salvage through coronary collateral growth by granulocyte colony-stimulating factor in chronic coronary
Pascal Meier1, Steffen Gloekler, Stefano F de Marchi
1Professor of Medicine and Co-Chairman of Cardiology, University Hospital, CH-3010 Bern, Switzerland.
Insights
Granulocyte colony-stimulating factor (G-CSF) effectively promotes coronary collateral growth, improving myocardial salvage in patients with coronary artery disease. This study demonstrates G-CSF
Area of Science:
- Cardiovascular Medicine
- Regenerative Medicine
- Pharmacology
Background:
- The role of granulocyte colony-stimulating factor (G-CSF) in promoting coronary collateral growth and subsequent myocardial salvage remains uninvestigated.
- Coronary artery disease necessitates strategies to enhance collateral circulation for improved heart muscle preservation.
Purpose of the Study:
- To evaluate the efficacy of G-CSF in promoting coronary collateral growth and myocardial salvage in patients with chronic stable coronary artery disease.
- To assess the impact of G-CSF on markers of infarct size and quantitative collateral function.
Main Methods:
- A randomized, placebo-controlled, double-blind study involving 52 patients with coronary artery disease.
- Patients received subcutaneous G-CSF (10 microg/kg) or placebo for two weeks.
- Collateral function was assessed using the collateral flow index (CFI) and ST-segment elevation during coronary balloon occlusion.
Main Results:
- G-CSF treatment led to a significant reduction in ST-segment elevation, indicating smaller infarct size, compared to placebo (21% vs. 0%, P=0.0005).
- G-CSF significantly improved collateral flow index (CFI) from baseline (0.121 to 0.166, P<0.0001).
- The placebo group showed no significant change in CFI (0.152 to 0.131, P<0.0001).
Conclusions:
- Subcutaneous G-CSF is effective in a short-term protocol for enhancing myocardial salvage.
- G-CSF promotes coronary collateral growth, offering a potential therapeutic strategy for ischemic heart disease.
Background:
The efficacy of granulocyte colony-stimulating factor (G-CSF) for coronary collateral growth promotion and thus impending myocardial salvage has not been studied so far, to our best knowledge.
Methods And Results:
In 52 patients with chronic stable coronary artery disease, age 62+/-11 years, the effect on a marker of myocardial infarct size (ECG ST segment elevation) and on quantitative collateral function during a 1-minute coronary balloon occlusion was tested in a randomized, placebo-controlled, double-blind fashion. The study protocol before coronary intervention consisted of occlusive surface and intracoronary lead ECG recording as well as collateral flow index (CFI, no unit) measurement in a stenotic and a > or =1 normal coronary artery before and after a 2-week period with subcutaneous G-CSF (10 microg/kg; n=26) or placebo (n=26). The CFI was determined by simultaneous measurement of mean aortic, distal coronary occlusive, and central venous pressure. The ECG ST segment elevation >0.1 mV disappeared significantly more often in response to G-CSF (11/53 vessels; 21%) than to placebo (0/55 vessels; P=0.0005), and simultaneously, CFI changed from 0.121+/-0.087 at baseline to 0.166+/-0.086 at follow-up in the G-CSF group, and from 0.152+/-0.082 to 0.131+/-0.071 in the placebo group (P<0.0001 for interaction of treatment and time). The absolute change in CFI from baseline to follow-up amounted to +0.049+/-0.062 in the G-CSF group and to -0.010+/-0.060 in the placebo group (P<0.0001).
Conclusions:
Subcutaneous G-CSF is efficacious during a short-term protocol in improving signs of myocardial salvage by coronary collateral growth promotion.
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