Ince H, Valgimigli M, Petzsch M, de Lezo J Suarez, Kuethe F, Dunkelmann S, Biondi-Zoccai G, Nienaber C A
Department of Medicine, Divisions of Cardiology at the University Hospital Rostock, Rostock School of Medicine, Rostock, Germany.
Heart. 2008 May;94(5):610-6. doi: 10.1136/hrt.2006.111385. Epub 2007 Aug 29.
Because of the recently published results of the MAGIC study there is confusion as to whether administration of granulocyte-colony stimulating factor (G-CSF) after acute myocardial infarction (MI) should be regarded as a potentially harmful treatment. This meta-analysis of appropriate clinical studies is intended to show the impact of G-CSF given after MI on aggravated incidence of coronary re-stenosis or progression of coronary lesions.
We used a fixed effects model based on the Mantel-Haenszel method to combine results from the different trials. These studies provided the basis for the current analysis comprising 106 patients of whom 62 were subjected to G-CSF treatment.
Minimum lumen diameter (MLD) measured immediately after percutaneous coronary intervention (PCI) was similar in both groups with a diameter stenosis of 12.3% (SD 9.5%) in the G-CSF group and 10.3% (8.5%) in the control group (p = 0.32). At follow-up, both MLD and percentage stenosis were not different between G-CSF-treated and control patients. Subsequently, averaged late lumen loss revealed similar results and no differences between groups (p = 0.11), and neither stent thrombosis nor re-infarction in either group.
The current meta-analysis of clinical reports fails to justify an elevated risk for coronary re-stenosis after PCI in acute MI or adverse events following G-CSF in the setting of MI when used after state of the art treatment in carefully conducted clinical protocols.
由于最近公布的MAGIC研究结果，对于急性心肌梗死后给予粒细胞集落刺激因子（G-CSF）是否应被视为一种潜在有害的治疗方法存在困惑。这项对适当临床研究的荟萃分析旨在显示心肌梗死后给予G-CSF对冠状动脉再狭窄加重发生率或冠状动脉病变进展的影响。
我们使用基于Mantel-Haenszel方法的固定效应模型来合并不同试验的结果。这些研究为当前分析提供了基础，该分析包括106例患者，其中62例接受了G-CSF治疗。
经皮冠状动脉介入治疗（PCI）后立即测量的最小管腔直径（MLD）在两组中相似，G-CSF组的直径狭窄率为12.3%（标准差9.5%），对照组为10.3%（8.5%）（p = 0.32）。在随访中，G-CSF治疗组和对照组患者的MLD和狭窄百分比均无差异。随后，平均晚期管腔丢失显示出相似的结果，两组之间无差异（p = 0.11），两组均未发生支架血栓形成或再梗死。
目前对临床报告的荟萃分析未能证明在精心制定的临床方案中，急性心肌梗死后PCI后冠状动脉再狭窄风险升高或心肌梗死情况下G-CSF治疗后不良事件风险升高是合理的。
