TY - JOUR
T1 - Instent neointimal hyperplasia after percutaneous intervention for ST-elevation myocardial infarction and treatment with granulocyte-colony stimulating factor. Results from the stem cells in myocardial infarction (STEMMI) trial
AU - Jørgensen, Erik
AU - Baldazzi, Federica
AU - Ripa, Rasmus Sejersten
AU - Friis, Tina
AU - Wang, Yongzong
AU - Helqvist, Steffen
AU - Kastrup, Jens
N1 - Copyright © 2008 Elsevier Ireland Ltd. All rights reserved.
PY - 2010/3/18
Y1 - 2010/3/18
N2 - Background: Recombinant granulocyte-colony stimulating factor (G-CSF) mobilized pluripotent cells from the bone marrow are proposed to have a regenerative potential. Though, a report of excessive instent restenosis, in patients treated with G-CSF before percutaneous coronary intervention (PCI) warrants caution. Methods: Patients (n=59) enrolled in the STEMMI trial, a randomized and double blind study, comparing G-CSF and placebo after large ST-elevation myocardial infarctions, had an intracoronary ultrasound imaging at 6 months follow-up with a quantitative analysis of instent neointimal hyperplasia. Results: During G-CSF treatment leukocyte counts, and CD34+ and CD45-/CD34- cell fractions in peripheral blood increased markedly (p<0.0001 vs. placebo). At follow-up, there were no differences in intracoronary late lumen loss, expressed as neointima volume per mm of stent (1.6 mm 3±1.2 [G-CSF group] vs. 1.9 mm3 ±1.3 [placebo group]; p=0.38), and in minimal instent lumen area (5.4 mm2 ±2.4 vs. 5.3 mm2±2.6, p=0.90). In the placebo group, plasma concentration of stromal cell-derived factor-1 (SDF-1) increased significantly after STEMI. This SDF-1 response was completely suppressed during G-CSF treatment. A rebound increase of SDF-1 was observed after withdrawal of G-CSF (p=0.001). Plasma concentration of SDF-1 at the time of stent implantation correlated positively to neointimal hyperplasia (p=0.025). Conclusions: G-CSF treatment, initiated after PCI, does not lead to excessive instent neointimal hyperplasia or restenosis in patients with STEMI. The timing of G-CSF, in relation to the PCI, might be important, as G-CSF influences SDF-1.
AB - Background: Recombinant granulocyte-colony stimulating factor (G-CSF) mobilized pluripotent cells from the bone marrow are proposed to have a regenerative potential. Though, a report of excessive instent restenosis, in patients treated with G-CSF before percutaneous coronary intervention (PCI) warrants caution. Methods: Patients (n=59) enrolled in the STEMMI trial, a randomized and double blind study, comparing G-CSF and placebo after large ST-elevation myocardial infarctions, had an intracoronary ultrasound imaging at 6 months follow-up with a quantitative analysis of instent neointimal hyperplasia. Results: During G-CSF treatment leukocyte counts, and CD34+ and CD45-/CD34- cell fractions in peripheral blood increased markedly (p<0.0001 vs. placebo). At follow-up, there were no differences in intracoronary late lumen loss, expressed as neointima volume per mm of stent (1.6 mm 3±1.2 [G-CSF group] vs. 1.9 mm3 ±1.3 [placebo group]; p=0.38), and in minimal instent lumen area (5.4 mm2 ±2.4 vs. 5.3 mm2±2.6, p=0.90). In the placebo group, plasma concentration of stromal cell-derived factor-1 (SDF-1) increased significantly after STEMI. This SDF-1 response was completely suppressed during G-CSF treatment. A rebound increase of SDF-1 was observed after withdrawal of G-CSF (p=0.001). Plasma concentration of SDF-1 at the time of stent implantation correlated positively to neointimal hyperplasia (p=0.025). Conclusions: G-CSF treatment, initiated after PCI, does not lead to excessive instent neointimal hyperplasia or restenosis in patients with STEMI. The timing of G-CSF, in relation to the PCI, might be important, as G-CSF influences SDF-1.
KW - Aged
KW - Angioplasty, Balloon, Coronary
KW - Double-Blind Method
KW - Female
KW - Follow-Up Studies
KW - Granulocyte Colony-Stimulating Factor
KW - Hematopoietic Stem Cell Mobilization
KW - Humans
KW - Hyperplasia
KW - Male
KW - Mesenchymal Stromal Cells
KW - Middle Aged
KW - Myocardial Infarction
KW - Neointima
KW - Prospective Studies
KW - Recombinant Proteins
KW - Stents
KW - Treatment Outcome
U2 - 10.1016/j.ijcard.2008.10.029
DO - 10.1016/j.ijcard.2008.10.029
M3 - Journal article
C2 - 19056135
SN - 0167-5273
VL - 139
SP - 269
EP - 275
JO - International Journal of Cardiology
JF - International Journal of Cardiology
IS - 3
ER -