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

Abstract

Background— 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. Methods and Results— 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 ≥1 normal coronary artery before and after a 2-week period with subcutaneous G-CSF (10 μg/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 <0.0001 for interaction of treatment and time). The absolute change in CFI from baseline to follow-up amounted to +0.049±0.062 in the G-CSF group and to −0.010±0.060 in the placebo group ( P <0.0001). Conclusions— Subcutaneous G-CSF is efficacious during a short-term protocol in improving signs of myocardial salvage by coronary collateral growth promotion.