Low-dose and long-term G-CSF treatment can improve severe myocardial ischemia in patients with severe coronary artery disease

Background It has been reported that granulocyte colony-stimulating factor (G-CSF) can promote angiogenesis by mobilizing bone marrow stem cells to blood vessels. The purpose of this study is to clarify whether low-dose and long-term G-CSF treatment can improve severe myocardial ischemia. Methods We studied 40 patients (M/F = 29/11, age = 68 ± 9 years) who had severe coronary artery disease (7 with and 5 without old myocardial infarction; 3VD/2VD/1VD = 17/17/6) and severe myocardial ischemia with no indication for revascularization. G-CSF (1.5 μg/kg) was injected for 14 consecutive days. All patients were evaluated using stress myocardial scintigraphy, the Canadian Cardiovascular Society (CCVS) score, and cardiopulmonary exercise testing before and after 3 months of treatment. On 17 SPECT segments, the total defect score (TDS) and delta TDS (TDS (stress) minus TDS (resting)) were evaluated to assess the severity of myocardial ischemia. Results The changes in stress TDS, delta TDS, and regional wall motion score were significantly greater in the G-CSF group than the control group ( P < .0001). The CCVS score improved significantly from baseline to the 3-month follow-up assessment in the G-CSF group ( P < .0001). The increase of peak VO 2 was significantly larger in the G-CSF group than the control group ( P = .015). Conclusion Low-dose and long-term G-CSF treatment can improve severe ischemia in patients with severe coronary artery disease.