In patients with coronary artery disease (CAD) receiving percutaneous coronary intervention (PCI), the use of the anti-inflammatory agent colchicine is associated with a significant reduction in major adverse cardiovascular events (MACE), according to a study published in the journal Open Heart.
The systemic review and meta-analysis used the PICO tool (P=patients with symptomatic CAD who received PCI; I=colchicine in addition to conventional guideline therapy; C=placebo in addition to conventional guideline therapy; O=MACE). Inclusion criteria were (1) studies that compared the efficacy of colchicine vs placebo or no colchicine in patients receiving PCI, with the reporting of MACE; (2) patients treated according to local guidelines for CAD; (3) randomized controlled trial (RCT) study design; (4) studies in English. Primary outcome measures were MACE, including in-stent restenosis (ISR), repeat vessel revascularization, stent thrombosis, stroke, resuscitated cardiac arrest, and all-cause mortality.
Overall, 7 RCTs were systematically reviewed and meta-analyzed. This included a total of 6660 patients—3347 in the colchicine arm and 3313 in the control arm. The mean patient age was 60.9±10.0 years. Among the 7 RCTs, 6 studies included participants with less than or equal to a 13.5-day history of ACS. One study included individuals with both ACS and chronic coronary syndrome. All of the follow-up studies lasted from 3 days to 22.6 months.
Based on quantitative analysis of pooled outcomes from the 7 RCTs, the use of colchicine in patients who received PCI was associated with a significant decrease in the occurrence of MACE outcomes (risk ratio [RR], 0.73; 95% CI, 0.61 to 0.87; P=.0003). In 3 of the studies that reported angiographically proven ISR, the meta-analysis demonstrated no statistically significant reduction in ISR with colchicine use in patients who received PCI (RR, 0.64; 95% CI, 0.36 to 1.15; P=.14).
Further, meta-analysis of 4 of the studies revealed a significant decrease in repeat vessel revascularization when colchicine therapy was used in patients receiving PCI (RR, 0.47; 95% CI, 0.31 to 0.72; P=.0004). Additionally, a significant reduction in stent thrombosis was reported when colchicine was administered to patients who received PCI (RR, 0.50; 95% CI, 0.25 to 0.98; P=.05). Per pooled outcomes of the 7 RCTs, a significant reduction in stroke was observed when colchicine was used as a treatment in patients receiving PCI (RR, 0.50; 95% CI, 0.31 to 0.81; P=.005). Regarding all-cause mortality, no significant difference was reported in patients receiving PCI who received colchicine vs those who did not (RR, 1.12; 95% CI, 0.49 to 2.58; P=.79).
“Colchicine significantly reduces the risk of MACE in patients with symptomatic CAD who have undergone PCI,” the investigators noted. “Further clinical trials are required to evaluate the clinical benefits of colchicine use with different types of stents and alternative dosing regimens.”
Disclosure: None of the study authors has declared affiliations with biotech, pharmaceutical, and/or device companies.
Aw KL, Koh A, Lee HL, Kudzinskas A, De Palma R. Colchicine for symptomatic coronary artery disease after percutaneous coronary intervention. Open Heart. Published online January 6, 2022. doi:10.1136/openhrt-2021-001887