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G-CSF Treatment for STEMI: Final 3-Year Follow-up of the Randomised Placebo-Controlled STEM-AMI Trial
Study Questions:
What are the long-term effects of granulocyte colony-stimulating factor (G-CSF) treatment on cardiac function following anterior acute myocardial infarction (MI)?
Methods:
This was a prospective trial of 60 patients who underwent primary percutaneous coronary intervention (PCI) for anterior ST-segment elevation MI (STEMI) randomized to G-CSF or placebo. Clinical events and major adverse cardiac and cerebrovascular events (MACCE) were monitored, and left ventricular (LV) ejection fraction, LV end-diastolic (LVEDV) and end-systolic (LVESV) volumes, and infarct size were evaluated by magnetic resonance imaging at 3-year follow-up.
Results:
No significant differences were found in mortality, MACCE, and infarct size between G-CSF and placebo-treated groups. LVEDV was significantly lower in G-CSF than in placebo patients (170.1 ± 8.1 vs. 197.2 ± 8.9 ml; p = 0.033). An inverse correlation was detected in G-CSF patients between the number of circulating CD34 cells at 30 days after reperfusion and the 3-year absolute and indexed LVEDV.
Conclusions:
The authors concluded that G-CSF therapy may be beneficial in attenuating ventricular remodeling subsequent to a large anterior STEMI in the long-term, while no differences have been detected in clinical outcome.
Perspective:
Several clinical trials testing cell-based or growth factor strategies to repair or regenerate infarcted myocardium have met with very limited success. This relatively small trial with the growth factor, G-CSF, shows no beneficial effect on infarct size or clinical outcomes. A possible benefit on LV remodeling is present that may be related to the mobilization of circulating CD34 progenitor cells in response to G-CSF following the acute event. Much larger clinical trials would be needed to determine the clinical significance of this effect.
Keywords: Myocardial Infarction, Follow-Up Studies, Ventricular Function, Left, Ventricular Remodeling, Myocardium, Percutaneous Coronary Intervention, Granulocyte Colony-Stimulating Factor
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