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

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.
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.
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.
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.
After a heart attack, part of the heart muscle is damaged, and many patients later develop reduced heart function despite modern treatments. Granulocyte colony-stimulating factor (G-CSF) is a drug that increases the release of stem cells from the bone marrow and has been studied as a way to help the heart heal after a heart attack. This study combined results from 11 randomized clinical trials, including 1,073 patients who received either G-CSF plus standard care or standard care alone. We analyzed heart function, heart size, and major clinical outcomes such as death, repeat heart attack, artery re-narrowing, and need for further procedures. G-CSF did not reduce deaths, recurrent heart attacks, restenosis, or revascularization. Some studies using echocardiography showed small improvements in heart function and heart size, but these findings were not confirmed by cardiac MRI, a more accurate imaging method. Overall, G-CSF appears safe but does not provide meaningful clinical benefits after a heart attack. Further high-quality studies would be needed to define any potential role.