title: Late reperfusion of a totally occluded infarct-related artery increases granulocyte-colony stimulation factor and reduces stroma-derived factor-1alpha blood levels in patients with ongoing ischemia after acute myocardial infarction.
abstract: After acute myocardial infarction (AMI), reopening of a totally occluded infarct-related artery (IRA) at a subacute stage is still controversial in symptom-free patients. However, in patients with persistent ischemic symptoms and inadequate collaterals to the infarct area, recanalization is thought to provide beneficial effects. In addition to augmenting myocardial perfusion, we hypothesized that the benefit of recanalization involves the manipulation of circulating stem cell-mobilizing cytokines. This study included 30 patients with a totally occluded IRA and ongoing ischemic symptoms (the study group) and 30 patients with a partially occluded IRA (the control group). All patients underwent successful angioplasty and/or stenting. Before and immediately after the coronary intervention, blood granulocyte-colony-stimulating factor (G-CSF), stem-cell factor (SCF), vascular endothelial growth factor (VEGF), and stroma-derived factor-1 (SDF-1alpha) were measured. After recanalization, G-CSF levels significantly increased in the study group compared to the control group (P=0.03). SDF-1alpha levels in the study group decreased relative to the controls (P=0.02). However, no significant changes in VEGF or SCF levels between the two groups were found. In the multivariate analysis, reopening of a totally occluded IRA was independently and significantly associated with changes in G-CSF and SDF-1alpha levels after recanalization. In conclusion, our data suggest that the benefits of late reperfusion of a totally occluded IRA in patients with ongoing myocardial ischemia may involve mechanisms associated with stem cell-mobilizing and plaque-stabilizing cytokines. This study provides the rationale to investigate serial changes in cytokines and the numbers of circulating progenitors after reperfusion in the future.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Li-Tang
authors.initials: LT
authors.lastname: Kuo
authors.forename: Shih-Jen
authors.initials: SJ
authors.lastname: Chen
authors.forename: Wen-Jin
authors.initials: WJ
authors.lastname: Cherng
authors.forename: Ning-I
authors.initials: NI
authors.lastname: Yang
authors.forename: Chen-Chin
authors.initials: CC
authors.lastname: Lee
authors.forename: Chi-Wen
authors.initials: CW
authors.lastname: Cheng
authors.forename: Subodh
authors.initials: S
authors.lastname: Verma
authors.forename: Chao-Hung
authors.initials: CH
authors.lastname: Wang
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D054377:Chemokine CXCL12 / Q000097:blood*; D023903:Coronary Restenosis / Q000097:blood* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D012307:Risk Factors; D019089:Stem Cell Factor / Q000097:blood; D013318:Stroke Volume / Q000502:physiology; D013997:Time Factors; D042461:Vascular Endothelial Growth Factor A / Q000097:blood
chemical_list: D054377:Chemokine CXCL12; D019089:Stem Cell Factor; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A; D016179:Granulocyte Colony-Stimulating Factor