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Hibbert B, Hayley B, Beanlands RS, Le May M, Davies R, So D, Marquis JF, Labinaz M, Froeschl M, O'Brien ER, Burwash IG, Wells GA, Pourdjabbar A, Simard T, Atkins H, Glover C. Granulocyte colony-stimulating factor therapy for stem cell mobilization following anterior wall myocardial infarction: the CAPITAL STEM MI randomized trial. CMAJ 2014; 186:E427-34. [PMID: 24934893 DOI: 10.1503/cmaj.140133] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
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.
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Affiliation(s)
- Benjamin Hibbert
- Division of Cardiology (Hibbert, Hayley, Beanlands, Le May, Davies, So, Marquis, Labinaz, Froeschl, O'Brien, Burwash, Wells, Pourdjabbar, Simard, Glover), Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ont.; Libin Cardiovascular Institute (O'Brien), Calgary, Alta.; Division of Hematology (Atkins), Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ont
| | - Bradley Hayley
- Division of Cardiology (Hibbert, Hayley, Beanlands, Le May, Davies, So, Marquis, Labinaz, Froeschl, O'Brien, Burwash, Wells, Pourdjabbar, Simard, Glover), Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ont.; Libin Cardiovascular Institute (O'Brien), Calgary, Alta.; Division of Hematology (Atkins), Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ont
| | - Robert S Beanlands
- Division of Cardiology (Hibbert, Hayley, Beanlands, Le May, Davies, So, Marquis, Labinaz, Froeschl, O'Brien, Burwash, Wells, Pourdjabbar, Simard, Glover), Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ont.; Libin Cardiovascular Institute (O'Brien), Calgary, Alta.; Division of Hematology (Atkins), Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ont
| | - Michel Le May
- Division of Cardiology (Hibbert, Hayley, Beanlands, Le May, Davies, So, Marquis, Labinaz, Froeschl, O'Brien, Burwash, Wells, Pourdjabbar, Simard, Glover), Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ont.; Libin Cardiovascular Institute (O'Brien), Calgary, Alta.; Division of Hematology (Atkins), Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ont
| | - Richard Davies
- Division of Cardiology (Hibbert, Hayley, Beanlands, Le May, Davies, So, Marquis, Labinaz, Froeschl, O'Brien, Burwash, Wells, Pourdjabbar, Simard, Glover), Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ont.; Libin Cardiovascular Institute (O'Brien), Calgary, Alta.; Division of Hematology (Atkins), Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ont
| | - Derek So
- Division of Cardiology (Hibbert, Hayley, Beanlands, Le May, Davies, So, Marquis, Labinaz, Froeschl, O'Brien, Burwash, Wells, Pourdjabbar, Simard, Glover), Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ont.; Libin Cardiovascular Institute (O'Brien), Calgary, Alta.; Division of Hematology (Atkins), Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ont
| | - Jean-François Marquis
- Division of Cardiology (Hibbert, Hayley, Beanlands, Le May, Davies, So, Marquis, Labinaz, Froeschl, O'Brien, Burwash, Wells, Pourdjabbar, Simard, Glover), Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ont.; Libin Cardiovascular Institute (O'Brien), Calgary, Alta.; Division of Hematology (Atkins), Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ont
| | - Marino Labinaz
- Division of Cardiology (Hibbert, Hayley, Beanlands, Le May, Davies, So, Marquis, Labinaz, Froeschl, O'Brien, Burwash, Wells, Pourdjabbar, Simard, Glover), Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ont.; Libin Cardiovascular Institute (O'Brien), Calgary, Alta.; Division of Hematology (Atkins), Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ont
| | - Michael Froeschl
- Division of Cardiology (Hibbert, Hayley, Beanlands, Le May, Davies, So, Marquis, Labinaz, Froeschl, O'Brien, Burwash, Wells, Pourdjabbar, Simard, Glover), Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ont.; Libin Cardiovascular Institute (O'Brien), Calgary, Alta.; Division of Hematology (Atkins), Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ont
| | - Edward R O'Brien
- Division of Cardiology (Hibbert, Hayley, Beanlands, Le May, Davies, So, Marquis, Labinaz, Froeschl, O'Brien, Burwash, Wells, Pourdjabbar, Simard, Glover), Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ont.; Libin Cardiovascular Institute (O'Brien), Calgary, Alta.; Division of Hematology (Atkins), Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ont
| | - Ian G Burwash
- Division of Cardiology (Hibbert, Hayley, Beanlands, Le May, Davies, So, Marquis, Labinaz, Froeschl, O'Brien, Burwash, Wells, Pourdjabbar, Simard, Glover), Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ont.; Libin Cardiovascular Institute (O'Brien), Calgary, Alta.; Division of Hematology (Atkins), Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ont
| | - George A Wells
- Division of Cardiology (Hibbert, Hayley, Beanlands, Le May, Davies, So, Marquis, Labinaz, Froeschl, O'Brien, Burwash, Wells, Pourdjabbar, Simard, Glover), Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ont.; Libin Cardiovascular Institute (O'Brien), Calgary, Alta.; Division of Hematology (Atkins), Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ont
| | - Ali Pourdjabbar
- Division of Cardiology (Hibbert, Hayley, Beanlands, Le May, Davies, So, Marquis, Labinaz, Froeschl, O'Brien, Burwash, Wells, Pourdjabbar, Simard, Glover), Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ont.; Libin Cardiovascular Institute (O'Brien), Calgary, Alta.; Division of Hematology (Atkins), Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ont
| | - Trevor Simard
- Division of Cardiology (Hibbert, Hayley, Beanlands, Le May, Davies, So, Marquis, Labinaz, Froeschl, O'Brien, Burwash, Wells, Pourdjabbar, Simard, Glover), Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ont.; Libin Cardiovascular Institute (O'Brien), Calgary, Alta.; Division of Hematology (Atkins), Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ont
| | - Harold Atkins
- Division of Cardiology (Hibbert, Hayley, Beanlands, Le May, Davies, So, Marquis, Labinaz, Froeschl, O'Brien, Burwash, Wells, Pourdjabbar, Simard, Glover), Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ont.; Libin Cardiovascular Institute (O'Brien), Calgary, Alta.; Division of Hematology (Atkins), Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ont
| | - Christopher Glover
- Division of Cardiology (Hibbert, Hayley, Beanlands, Le May, Davies, So, Marquis, Labinaz, Froeschl, O'Brien, Burwash, Wells, Pourdjabbar, Simard, Glover), Department of Medicine, University of Ottawa Heart Institute, Ottawa, Ont.; Libin Cardiovascular Institute (O'Brien), Calgary, Alta.; Division of Hematology (Atkins), Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ont.
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