Myocardial Salvage Through Coronary Collateral Growth by Granulocyte Colony-Stimulating Factor in Chronic Coronary Artery Disease A Controlled Randomized Trial

• Published in: Circulation (New York, N.Y.) N.Y.), 2009-10, Vol.120 (14), p.1355-1363
• Main Authors: MEIER, Pascal, GLOEKLER, Steffen, DE MARCHI, Stefano F, INDERRNUEHLE, Andreas, RUTZ, Tobias, TRAUPE, Tobias, STECK, Hélène, VOGEL, Rolf, SEILER, Christian
• Format: Article
• Language: English
• Subjects: Aged; Angina Pectoris - physiopathology; Angioplasty, Balloon, Coronary; Biological and medical sciences; Blood and lymphatic vessels; Cardiac Catheterization; Cardiology. Vascular system; Cardiovascular Diseases - epidemiology; Chest Pain - epidemiology; Chronic Disease; Coronary Angiography; Coronary Artery Disease - drug therapy; Coronary heart disease; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Double-Blind Method; Echocardiography; Female; Granulocyte Colony-Stimulating Factor - therapeutic use; Heart; Humans; Hyperemia; Male; Medical sciences; Middle Aged; Myocardial Infarction - epidemiology; Myocardial Ischemia - physiopathology; Placebos; Risk Factors
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.109.866269

The efficacy of granulocyte colony-stimulating factor (G-CSF) for coronary collateral growth promotion and thus impending myocardial salvage has not been studied so far, to our best knowledge. In 52 patients with chronic stable coronary artery disease, age 62+/-11 years, the effect on a marker of myocardial infarct size (ECG ST segment elevation) and on quantitative collateral function during a 1-minute coronary balloon occlusion was tested in a randomized, placebo-controlled, double-blind fashion. The study protocol before coronary intervention consisted of occlusive surface and intracoronary lead ECG recording as well as collateral flow index (CFI, no unit) measurement in a stenotic and a > or =1 normal coronary artery before and after a 2-week period with subcutaneous G-CSF (10 microg/kg; n=26) or placebo (n=26). The CFI was determined by simultaneous measurement of mean aortic, distal coronary occlusive, and central venous pressure. The ECG ST segment elevation >0.1 mV disappeared significantly more often in response to G-CSF (11/53 vessels; 21%) than to placebo (0/55 vessels; P=0.0005), and simultaneously, CFI changed from 0.121+/-0.087 at baseline to 0.166+/-0.086 at follow-up in the G-CSF group, and from 0.152+/-0.082 to 0.131+/-0.071 in the placebo group (P