한빛사 논문
Abstract
The MAGIC Cell-3-DES Randomized, Controlled Trial
Hyun-Jae Kang, MD; Hae-Young Lee, MD; Sang-Hoon Na, MD; Sung-A Chang, MD; Kyung-Woo Park, MD; Hyung-Kwan Kim, MD; Song-Yi Kim, MD; Ho-Joon Chang, MD; Whal Lee, MD; Won Jun Kang, MD; Bon-Kwon Koo, MD; Yong-Jin Kim, MD; Dong Soo Lee, MD; Dae-Won Sohn, MD; Kyou-Sup Han, MD; Byung-Hee Oh, MD; Young-Bae Park, M D; Hyo-Soo Kim, MD
From the Cardiovascular Laboratory, Clinical Research Institute (H-J.K., H-Y.L., S-H.N., S-A.C., K-W.P., H-K.K., S-Y.K., H-J.C., B-K.K., Y-J.K., D-W.S., B-H.O., Y-B.P., H-S.K.), Cardiovascular Center (H-J.K., H-Y.L., S-H.N., S-A.C., K-W.P., H-K.K., S-Y.K., H-J.C., B-K.K., Y-J.K., D-W.S., B-H.O., Y-B.P., H-S.K.), Department of Internal Medicine (H-J.K., H-Y.L., S-H.N., S-A.C., K-W.P., H-K.K., S-Y.K., H-J.C., B-K.K., Y-J.K., D-W.S., B-H.O., Y-B.P., H-S.K.), Department of Radiology (W.L.), Department of Nuclear Medicine (W.J.K., D.S.L.), and Department of Laboratory Medicine (K-S.H.), Seoul National University Hospital, Seoul, Korea
Correspondence to Hyo-Soo Kim, MD or Young-Bae Park, MD, Department of Internal Medicine, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Republic of Korea
Background--The efficacy of intracoronary infusion of granulocyte colony-stimulating factor (G-CSF) mobilized peripheral blood stem cells (PBSCs) has not been compared between patients with acute (AMI) versus old myocardial infarction (OMI). In addition, the potential risk of restenosis associated with G-CSF-based stem cell therapy has not been evaluated in the setting of drug eluting stent (DES) implantation.
Methods and Results-- We randomly allocated 96 patients with myocardial infarction who underwent coronary revascularization with DES for the culprit lesion into 4 groups. Eighty-two patients completed 6-month follow-up; AMI cell infusion (n=25), AMI control (n=25), OMI cell infusion (n=16), and OMI control group (n=16). In cell infusion groups, PBSCs were mobilized by G-CSF for 3 days and delivered to infarcted myocardium via intracoronary infusion. The AMI cell infusion group showed a significant additive improvement in left ventricular ejection fraction (LVEF) and remodeling compared with controls (change of LVEF: +5.1±9.1% versus -0.2±8.6%, P<0.05; change of end-systolic volume: -5.4±17.0 mL versus 6.5±21.9 mL, P<0.05). In OMI patients, however, there was no significant change of LVEF and ventricular remodeling in spite of significant improvement of coronary flow reserve after cell infusion. G-CSF-based cell therapy did not aggravate neointimal growth with DES implantation.
Conclusions-- Intracoronary infusion of mobilized PBSCs with G-CSF improves LVEF and remodeling in patients with AMI but is less definite in patients with OMI. G-CSF-based stem cell therapy with DES implantation is both feasible and safe, eliminating any potential for restenosis.
Key Words: myocardial infarction, stem cell, G-CSF
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