"Colchicine in Patients with Recent Myocardial Infarction".The New England Journal of Medicine. 2019. DOI: 10.1056/NEJMoa1912388.
Links to original sources: Wiki Journal Post Full Journal Article
Does low-dose colchicine reduce the risk of ischemic cardiovascular events in patients with a recent myocardial infarction?
In patients with a recent myocardial infarction, low-dose colchicine (0.5 mg once daily) significantly reduced the occurrence of ischemic cardiovascular events compared with placebo.
Inflammatory processes are implicated in atherosclerosis and post-myocardial infarction complications. Colchicine is an oral antiinflammatory medication used for gout and pericarditis. The Colchicine Cardiovascular Outcomes Trial (COLCOT) aimed to evaluate the effect of colchicine on cardiovascular outcomes and its long-term safety in patients who had recently had a myocardial infarction.
As of the knowledge cutoff date, no specific guidelines reflect the results of this trial.
- Multicenter, double-blind, randomized, placebo-controlled trial - N=4,745; 2,366 to colchicine, 2,379 to placebo - Setting: 167 centers in 12 countries - Enrollment: December 2015 - August 2018 - Follow-up: Median 22.6 months - Analysis: Intention-to-treat - Primary outcome: Composite of death from cardiovascular causes, resuscitated cardiac arrest, myocardial infarction, stroke, or urgent hospitalization for angina leading to coronary revascularization
- Adult patients within 30 days post-myocardial infarction - Completed planned percutaneous revascularization procedures - Treated according to national guidelines including intensive statin use - Exclusions: Severe heart failure, LVEF < 35%, stroke in previous 3 months, type 2 MI, recent or planned CABG, recent noncutaneous cancer, inflammatory bowel disease, nontransient creatine kinase elevation, hematologic or severe renal/hepatic disease, substance abuse, long-term systemic glucocorticoid therapy, sensitivity to colchicine
- Randomly assigned to receive colchicine (0.5 mg once daily) or placebo
- Primary outcome occurred in 5.5% (colchicine) compared with 7.1% (placebo) (HR 0.77; 95% CI 0.61-0.96; P=0.02) - Stroke (HR 0.26; 95% CI 0.10-0.70) - Urgent hospitalization for angina leading to coronary revascularization (HR 0.50; 95% CI 0.31-0.81) - Diarrhea reported in 9.7% (colchicine) vs 8.9% (placebo) (P=0.35) - Pneumonia as a serious adverse event in 0.9% (colchicine) vs 0.4% (placebo) (P=0.03)
- The trial's follow-up duration was relatively short (~23 months), limiting assessment of long-term treatment with colchicine. - Risks and benefits of prolonged colchicine therapy were not established. - Results apply only to patients with recent myocardial infarction and may not generalize to other patient groups.
Supported by the Government of Quebec, the Canadian Institutes of Health Research, philanthropic foundations, with the funds administered by the Montreal Heart Institute.
Additional information and related trial results can be found at NEJM.org and ClinicalTrials.gov with identifier NCT02551094.