Stem cell mobilization induced by subcutaneous granulocyte-colony stimulating factor to improve cardiac regeneration after acute ST-elevation myocardial infarction - Result of the double-blind, randomized, placebo-controlled stem cells in myocardial infarction (STEMMI) trial

被引:260
作者
Ripa, RS
Jorgensen, E
Wang, YZ
Thune, JJ
Nilsson, JC
Sondergaard, L
Johnsen, HE
Kober, L
Grande, P
Kastrup, J [1 ]
机构
[1] Univ Hosp, Rigshosp, Heart Ctr, Cardiac Catheterizat Lab 2014,Med Dept B, DK-2100 Copenhagen O, Denmark
[2] Univ Hosp, Rigshosp, Heart Ctr, Dept Radiol, DK-2100 Copenhagen O, Denmark
[3] Univ Hosp Hvidovre, Danish Res Ctr Magnet Resonance, Hvidovre, Denmark
[4] Aalborg Univ Hosp, Dept Haematol, Aalborg, Denmark
关键词
angiogenesis; heart failure; magnetic resonance imaging; myocardial infarction; stem cells;
D O I
10.1161/CIRCULATIONAHA.105.610469
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Phase 1 clinical trials of granulocyte-colony stimulating factor (G-CSF) treatment after myocardial infarction have indicated that G-CSF treatment is safe and may improve left ventricular function. This randomized, double-blind, placebo-controlled trial aimed to assess the efficacy of subcutaneous G-CSF injections on left ventricular function in patients with ST-elevation myocardial infarction. Methods and Results: Seventy-eight patients (62 men; average age, 56 years) with ST-elevation myocardial infarction were included after successful primary percutaneous coronary stent intervention < 12 hours after symptom onset. Patients were randomized to double-blind treatment with G-CSF (10 mu g/kg of body weight) or placebo for 6 days. The primary end point was change in systolic wall thickening from baseline to 6 months determined by cardiac magnetic resonance imaging (MRI). An independent core laboratory analyzed all MRI examinations. Systolic wall thickening improved 17% in the infarct area in the G-CSF group and 17% in the placebo group (P = 1.0). Comparable results were found in infarct border and noninfarcted myocardium. Left ventricular ejection fraction improved similarly in the 2 groups measured by both MRI (8.5 versus 8.0; P = 0.9) and echocardiography (5.7 versus 3.7; P = 0.7). The risk of severe clinical adverse events was not increased by G-CSF. In addition, in-stent late lumen loss and target vessel revascularization rate in the follow-up period were similar in the 2 groups. Conclusions: Bone marrow stem cell mobilization with subcutaneous G-CSF is safe but did not lead to further improvement in ventricular function after acute myocardial infarction compared with the recovery observed in the placebo group.
引用
收藏
页码:1983 / 1992
页数:10
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