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Safety and Efficacy of Subcutaneous-Only Granulocyte-Macrophage Colony-Stimulating Factor for Collateral Growth Promotion in Patients With Coronary Artery Disease

Department of Cardiology, University Hospital, Bern, Switzerland

View larger version (112K): [in a new window]   Figure 1 Determination of collateral flow index (CFI) in a patient receiving placebo before (left) and after treatment (right). Surface (III, avF) and intracoronary (i.c.) electrocardiogram (ECG) lead recordings are shown in the upper part of the panels. After 1 min of vessel occlusion before and after treatment, there are ST-segment elevations on the i.c. ECG lead, indicating coronary collaterals insufficient to prevent myocardial ischemia. Collateral flow index is calculated by dividing distal mean coronary occlusive pressure (Poccl, mm Hg) minus central venous pressure (CVP, mm Hg) by mean aortic pressure (Pao, mm Hg) minus CVP.

View larger version (50K): [in a new window]   Figure 2 Angiograms showing the right coronary artery of a patient receiving granulocyte-macrophage colony-stimulating factor. On the image taken before treatment (day 0), multiple proximal stenoses with hazy appearance are visible (). At day 9 of the treatment protocol, the patient was admitted to the hospital with an acute coronary syndrome; the extensively calcified right coronary artery was proximally occluded (middle panel), and could be successfully recanalized (right panel).

View larger version (20K): [in a new window]   Figure 3 Individual data of collateral flow index (CFI, vertical axis; black lines) obtained in stenotic as well as normal vessels before and after treatment (horizontal axis) among patients of the GM-CSF (granulocyte-macrophage colony-stimulating factor, left panel) and the placebo group (right panel). The blue lines connect the mean (± SD) CFI before and after treatment.

View larger version (29K): [in a new window]   Figure 4 Correlation between treatment-induced change in collateral flow index (CFI, vertical axis) and the respective change in tumor necrosis factor-alpha concentration (TNF-alpha, horizontal axis), i.e., the only independent predictor among 11 factors (see text) of CFI. Black symbols indicate values obtained in stenotic, blue symbols in normal vessels, respectively. *Value after treatment minus value before treatment.