Granulocyte colony stimulating factor for acute myocardial infarction: an updated systematic review and meta-analysis of randomized controlled trials.

Abstract

Introduction: Granulocyte Colony-Stimulating Factor (G-CSF) has been explored as a therapy to enhance myocardial repair after acute myocardial infarction (AMI). Earlier meta-analyses of randomized controlled trials (RCTs) reported no significant improvement but recently published studies warranted an updated synthesis.

Methods: We searched PubMed, Embase, Cochrane Library, and Web of Science for RCTs comparing G-CSF with placebo or standard care in AMI. Primary outcomes were left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and left ventricular ejection fraction (LVEF). Secondary outcomes were mortality, reinfarction, restenosis, and revascularization.

Results: Eleven RCTs encompassing 1,073 participants were included. G-CSF significantly reduced LVEDV in echocardiography studies (MD: -4.39 mL; 95% CI -6.80, -1.98; p < 0.001), whereas no effect was observed in MRI studies (MD: -0.19 mL; 95% CI -7.22, 6.84; p = 0.958). LVEF improved in the echocardiography subgroup (MD: 6.76%; 95% CI 1.62, 11.90; p = 0.010) but not in the MRI subgroup (MD: -0.08%; 95% CI -2.38, 2.22; p = 0.947). LVESV showed no significant differences. No effects were seen for mortality, reinfarction, restenosis, or revascularization.

Conclusion: G-CSF may confer structural benefits detectable by echocardiography, yet clinical outcomes remain unchanged. Larger, high-quality trials are needed to define its therapeutic role.