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

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.