| ǥ : Clinical award session
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ȣ - 480609 6 |
| Myocardial Regeneration and Angiogenesis in Myocardial Infarction with Granulocyte-Colony Stimulating Factor Mobilization and Intra-Coronary Cell Infusion [the MAGIC cell randomised clinical trial]: 1 year follow up |
| 서울대학교의과대학 내과학교실¹ ;서울대학교병원 임상의학연구소 심혈관연구실² ;서울대학교병원 핵의학과³ ;서울대학교병원 진단검사의학교실⁴ |
| 나상훈¹, 강현재¹ ,김효수¹ ,장서영 ² ,정진욱¹ ,조영석¹ ,연태진¹ ,구본권¹ ,김용진¹ ,채인호¹ ,이동수³ ,손대원¹ ,한규섭⁴ ,오병희¹,이명묵 ¹ ,박영배¹ ,최윤식¹ |
BACKGROUND: Intracoronary infusion of peripheral blood stem cells(PBSC) mobilized with G-CSF stimulation has been shown to improve cardiac function in patients with myocardial infarction[MI].We examined the feasibility and efficacy of G-CSF therapy and subsequent intracoronary infusion of collected peripheral blood stem-cells (PBSCs) in MI patients. METHODS AND RESULTS: We prospectively randomised 40 patients with MI who underwent coronary stenting for the culprit lesion of infarction into three groups; cell infusion after G-CSF (n=10), G-CSF alone (n=15), and control group (n=15).Changes in LV systolic function and perfusion were assessed after 6 months and 1 year. G-CSF injection and intracoronary infusion of the mobilized PBSC did not aggravate ischemia, substantial arrhythmia, inflammation or thrombotic complication. LV systolic function improved significantly in patients who received cell infusion (LVEF baseline to latest follow up; 48.9±8.9% to 56.7±6.8%, p=.003). There was no significant improvement observed in G-CSF alone and control group(53.5±13.0% to 54.0±10.7%,p=.847 and 47.6±8.5% to 50.2±9.9% ,p=.147).Change of LVEF at last follow up was higher in cell infusion group than G-CSF alone and control(7.8±6.1%:0.47±9.2%:2.6±6.5%, p=0.09).Regions of hypoperfused myocardium measured by SPECT were reduced at 6 months from 12.7±10.0% to 7.9±9.2%(p=.000)and this effect sustained through 1 year(7.4±9.6%) without significant difference observed between groups.In-stent restenosis rate at 6 months was higher in cell infusion and G-CSF alone group than control(50%:47%:13%, p=.085) without MI or death at 6 months. Sustained improvement of LV systolic function was observed in cell infusion group till 1 year(LVEF baselin to 1 year follow up , 48.9±8.9 to 56.4±6.7%, p=.023), but this effect was not observed in G-CSF alone group(53.5±13.0% to 53.6±11.3%, p=.790).
CONCLUSIONS: G-CSF therapy with intracoronary infusion of PBSC showed improved cardiac function. Higher in-stent restenosis was observed in G-CSF injection group without MI or death. Cardiac function improvement effect at 6 months following PBSC infusion therapy sustained till 1 year.
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