Granulocyte colony-stimulating factor attenuates left ventricular remodelling after acute anterior STEMI: results of the single-blind, randomized, placebo-controlled multicentre STem cEll Mobilization in Acute Myocardial Infarction (STEM-AMI) Trial

被引:31
作者
Achilli, Felice [1 ]
Malafronte, Cristina [1 ]
Lenatti, Laura [1 ]
Gentile, Francesco [2 ]
Dadone, Viola [2 ]
Gibelli, Giuseppe [3 ]
Maggiolini, Stefano [4 ]
Squadroni, Lidia [5 ]
Di Leo, Claudio [6 ]
Burba, Ilaria [7 ]
Pesce, Maurizio [7 ]
Mircoli, Luca [1 ]
Capogrossi, Maurizio C. [8 ]
Di Lelio, Alessandro [9 ]
Camisasca, Paola [10 ]
Morabito, Alberto [11 ]
Colombo, Gualtiero [12 ]
Pompilio, Giulio [13 ]
机构
[1] A Manzoni Hosp, Dept Cardiol, I-23900 Lecce, Italy
[2] Bassini Hosp, Dept Cardiol, Milan, Italy
[3] Clin San Carlo, Cardiol Unit, Paderno Dugnano, Italy
[4] San L Mand Hosp, Dept Cardiol, Merate, Lecco, Italy
[5] San Carlo Hosp, Dept Cardiol, Milan, Italy
[6] A Manzoni Hosp, Dept Nucl Med, I-23900 Lecce, Italy
[7] Ctr Cardiol Monzino IRCCS, Lab Vasc Biol & Regenerat Med, Milan, Italy
[8] Ist Dermopat Immacolata IRCCS, Lab Vasc Pathol, Rome, Italy
[9] San Gerardo Hosp, Dept Radiol, Monza, Italy
[10] San Gerardo Hosp, Dept Cardiol, Monza, Italy
[11] Univ Milan, Milan, Italy
[12] Ctr Cardiol Monzino IRCCS, Lab Immunol & Funct Gen, Milan, Italy
[13] Ctr Cardiol Monzino IRCCS, Dept Cardiovasc Surg, Milan, Italy
关键词
Myocardial infarction; Stem cells; G-CSF; Ventricular remodelling; G-CSF; HEART-FAILURE; REVASCULARIZATION; REGENERATION; RECOVERY; SAFETY; REPAIR; SIZE;
D O I
10.1093/eurjhf/hfq150
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
The aim of this study was to assess the effect of granulocyte colony-stimulating factor (G-CSF) on left ventricular (LV) function and volumes in patients with anterior ST-elevation myocardial infarction (STEMI) and depressed LV ejection fraction (EF). Sixty consecutive patients with anterior STEMI, undergoing primary angioplasty percutaneous coronary intervention (PCI), with symptom-to-reperfusion time of 2-12 h and EF < 45% after PCI, were randomized to G-CSF 5 mu g/kg b.i.d. subcutaneously (n = 24) or placebo (n = 25) for 5 days, starting < 12 h after PCI. The primary endpoint was an increase from baseline to 6 months of 5% in left ventricular ejection fraction (LVEF), as measured by magnetic resonance imaging (MRI). Co-primary endpoint was a >= 20 mL difference in end-diastolic volume (EDV). Infarct size and perfusion were evaluated with late gadolinium enhancement (LGE) and gated (99m)Technetium Sestamibi single-photon emission computed tomography (SPECT). Left ventricular EDV and end-systolic volume (ESV) increased from baseline to 6 months in the placebo group (81.7 +/- 24.4 to 94.4 +/- 26.0 mL/m(2), P < 0.00005 and 45.2 +/- 20.0 to 53.2 +/- 23.8 mL/m(2), P = 0.016) but were unchanged in the G-CSF group (82.2 +/- 20.3 to 85.7 +/- 23.7 mL/m(2), P = 0.40 and 46.0 +/- 18.2 to 48.4 +/- 20.8 mL/m(2), P = 0.338). There were no significant differences in EF or perfusion between groups. A significant reduction in transmural LGE segments was seen at 6 months in the G-CSF vs. placebo groups (4.38 +/- 2.9 to 3.3 +/- 2.6, P = 0.04 and 4.2 +/- 2.6 to 3.6 +/- 2.7, P = 0.301, respectively). Significantly more placebo patients had a change in left ventricular end-diastolic volume abovethe median (9.3 mL/m(2)) when reperfusion time exceeded 180 min (median time-to-reperfusion) (P = 0.0123). Severe adverse events were similar between groups. Early G-CSF administration attenuates ventricular remodelling in patients with anterior STEMI and EF < 45% after successful PCI.
引用
收藏
页码:1111 / 1121
页数:11
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