G-CSF in patients suffering from late revascularized ST elevation myocardial infarction: analysis on the timing of G-CSF administration.
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.


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.


CONCLUSIONS
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.
Engelmann
Markus G
MG
Medical Department I-Cardiology, Ludwig Maximilians University, Klinikum Grosshadern, Munich, Germany. markus.engelmann@med.uni-muenchen.de
Theiss
Hans D
HD
Theiss
Christine
C
Huber
Armin
A
Wintersperger
Bernd J
BJ
Werle-Ruedinger
Anja E
AE
Schoenberg
Stefan O
SO
Steinbeck
Gerhard
G
Franz
Wolfgang-M
WM
D000368:Aged; D004334:Drug Administration Schedule; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000008:administration & dosage / Q000627:therapeutic use*; D019650:Hematopoietic Stem Cell Mobilization; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000473:pathology; D009204:Myocardial Revascularization; D033581:Stem Cell Transplantation; D016896:Treatment Outcome
D016179:Granulocyte Colony-Stimulating Factor