PT  - JOURNAL ARTICLE
AU  - Benjamin Hibbert
AU  - Bradley Hayley
AU  - Robert S. Beanlands
AU  - Michel Le May
AU  - Richard Davies
AU  - Derek So
AU  - Jean-François Marquis
AU  - Marino Labinaz
AU  - Michael Froeschl
AU  - Edward R. O’Brien
AU  - Ian G. Burwash
AU  - George A. Wells
AU  - Ali Pourdjabbar
AU  - Trevor Simard
AU  - Harold Atkins
AU  - Christopher Glover
TI  - Granulocyte colony-stimulating factor therapy for stem cell mobilization following anterior wall myocardial infarction: the CAPITAL STEM MI randomized trial
AID  - 10.1503/cmaj.140133
DP  - 2014 Aug 05
TA  - Canadian Medical Association Journal
PG  - E427--E434
VI  - 186
IP  - 11
4099  - http://www.cmaj.ca/content/186/11/E427.short
4100  - http://www.cmaj.ca/content/186/11/E427.full
SO  - CMAJ2014 Aug 05; 186
AB  - Background: Small studies have yielded divergent results for administration of granulocyte colony-stimulating factor (G-CSF) after acute myocardial infarction. Adequately powered studies involving patients with at least moderate left ventricular dysfunction are lacking.Methods: Patients with left ventricular ejection fraction less than 45% after anterior-wall myocardial infarction were treated with G-CSF (10 μg/kg daily for 4 days) or placebo. After initial randomization of 86 patients, 41 in the placebo group and 39 in the G-CSF group completed 6-month follow-up and underwent measurement of left ventricular ejection fraction by radionuclide angiography.Results: Baseline and 6-week mean ejection fraction was similar for the G-CSF and placebo groups: 34.8% (95% confidence interval [CI] 32.6%–37.0%) v. 36.4% (95% CI 33.5%–39.2%) at baseline and 39.8% (95% CI 36.2%–43.4%) v. 43.1% (95% CI 39.2%–47.0%) at 6 weeks. However, G-CSF therapy was associated with a lower ejection fraction at 6 months relative to placebo (40.8% [95% CI 37.4%–44.2%] v. 46.0% [95% CI 42.7%–44.3%]). Both groups had improved left ventricular function, but change in left ventricular ejection fraction was lower in patients treated with G-CSF than in those who received placebo (5.7 [95% CI 3.4–8.1] percentage points v. 9.2 [95% CI 6.3–12.1] percentage points). One or more of a composite of several major adverse cardiac events occurred in 8 patients (19%) within each group, with similar rates of target-vessel revascularization.Interpretation: In patients with moderate left ventricular dysfunction following anterior-wall infarction, G-CSF therapy was associated with a lower 6-month left ventricular ejection fraction but no increased risk of major adverse cardiac events. Future studies of G-CSF in patients with left ventricular dysfunction should be monitored closely for safety. Trial registration: ClinicalTrials.gov, no. NCT00394498