Abstract 568: The Earliest Start of Granulocyte Colony-Stimulating Factor Therapy in Patients With Acute Myocardial Infarction Can Improve Myocardial Perfusion, Fatty Acid Metabolism and Cardiac Function in Subacute and Follow-up Periods
Granulocyte colony-stimulating factor (G-CSF) was reported to induce myocardial regeneration and vascularization by mobilization of bone marrow stem cells and reduce apoptosis of endothelial cells to the injured heart after acute myocardial infarction (AMI). Meta-analysis showed improvement in left ventricular ejection fraction (LVEF) in early G-CSF therapy after AMI. But there were no reports that G-CSF therapy was started during reperfusion therapy. The purpose of this study is to clarify whether the earliest start of G-CSF therapy can get beneficial effects. Forty consecutive patients with initial ST-segment elevation AMI randomly assigned to receive intravenous drip infusion (30min) of G-CSF at 2 μg/kg body weight (G-CSF group (G): M/F= 14/6, age= 64±9 y) or saline (control group (C): M/F= 17/3, age= 66±9 y) for 5 days. First drip infusion was administered during primary PCI just after hospitalization. All patients underwent nuclear cardiac examinations, cardiopulmonary-exercise-testing (AT and peak VO2) on subacute (SA) and 6 months (6M) periods. The summed defect score (TDS) of perfusion MIBI and fatty acid metabolism BMIPP imagings on 17 SPECT segments and LVEF, end-diastolic volume (EDV), end-systolic volume (ESV) and regional wall motion (RWM:−1=dyskinesis −4=normal) of AMI segments using MIBI-QGS were estimated. The restenosis rate, target lesion revascularization (TLR) rate and adverse cardiac events (MACE) were also evaluated for 1 year.
Results: There were no significant differences in basic characteristics, EDV (SA), AT and peak VO2 in both periods, restenosis rate, TLR rate and MACE between two groups. As compared to the control group, the G-CSF group demonstrated a greater reduction in MIBI-TDS (6M) (G:5.9±7.3 vs. C:13.1±10.8), BMIPP-TDS(SA) (G:15.3±10.5 vs. C:22.7±9.5), BMIPP-TDS(6M) (G:10.2±8.9 vs. C:16.8±9.0), ESV(SA) (G:54±28ml vs. C:76±40ml), ESV(6M) (G:45±24ml vs. C:65±35ml) and a greater increase in EF(SA) (G:54±11% vs. C:45±13%), EF(6M) (G:59±10% vs. C:51±11%), RWM(SA) (G:1.8±1.5 vs. C:1.4±1.4), RWM(6M) (G:3.0±1.5 vs. C:2.4±1.6).
Conclusion: The earliest start of G-CSF therapy in AMI patients can improve myocardial perfusion, fatty acid metabolism and cardiac function in subacute and follow-up periods.