Preprocedural Colchicine in Patients With Acute ST-elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: A Randomized Controlled Trial (PodCAST-PCI)

Abstract

Primary percutaneous coronary intervention (PPCI) is the gold standard of treatment in patients with acute ST-elevation myocardial infarction (STEMI). The no-reflow phenomenon (NRP) is a detrimental consequence of STEMI. Colchicine is an antiinflammatory drug that may help prevent the NRP and improve patient outcomes. In a randomized, double-blind, placebo-controlled clinical trial, 451 patients with acute STEMI who were candidates for PPCI and eligible for enrollment were randomized into the colchicine group (n = 229) and the control group (n = 222). About 321 patients were eligible to participate; 161 patients were assigned to the colchicine group, whereas 160 patients were assigned to the control group. Colchicine was administered 1 mg before PCI and 0.5 mg daily after the procedure until discharge. NRP, measured by angiographic findings including the thrombolysis in myocardial infarction flow grade and the thrombolysis in myocardial infarction myocardial perfusion grade, was reported as the primary outcome. Secondary end points included ST resolution 90 minutes after the procedure, P-selectin, high-sensitivity C-reactive protein, and troponin levels postprocedurally, predischarge ejection fraction, and major adverse cardiac events (MACE) at 1 month and 1 year after PPCI. NRP rates did not show a significant difference between the 2 groups (P = 0.98). Moreover, the levels of P-selectin, high-sensitivity C-reactive protein, and troponin were not significantly different. MACE and predischarge ejection fraction were also not significantly different between the groups. In patients with STEMI treated by PPCI, colchicine administered before PPCI was not associated with a signif-icant reduction in the NRP and MACE prevention (trial registration: IRCT20120111008698N23).

Early long-term low-dosage colchicine and major adverse cardiovascular events in patients with acute myocardial infarction: a systematic review and meta-analysis

“…The colchicine dosage and follow-up varied among the studies. In the colchicine groups, four trials ( 24 , 28 , 29 , 31 ) were performed with oral colchicine (0.5 mg) daily, whereas two trials ( 25 , 30 ) were conducted with 1 mg daily. The remaining two trials ( 26 , 27 ) used 0.5 or 1 mg daily based on patients' weight.…”

“…The remaining two trials ( 26 , 27 ) used 0.5 or 1 mg daily based on patients' weight. Additionally, two trials ( 29 , 30 ) received an oral loading dosage of 1 or 2 mg. The length of follow-up varied from five days to 22.7 months.…”

“…The meta-Analyses of Diaz-Arocutipa et al reported that subgroup analyses of colchicine's dose, follow-up duration, and treatment duration did not show a statistical difference ( 15 ). In contrast, our study included more trials ( 29 , 30 ) with patients with MI occurring within 12 h and completely excluded UA patients. Moreover, the COPS trial included in the previous meta-analysis used colchicine 0.5 mg twice per day and then a dose of 0.5 mg daily for 11 months ( 21 ).…”

“…Colchicine may interfere with neutrophil-platelet interactions for anti-thrombosis (6,14,39). Long-term colchicine treatment reduces plaque instability, particularly in low-intensity plaque volumes (6,28). However, COVERT-MI reported an unexpected three-fold increase in the incidence of left ventricular thrombosis, possibly due to a proinflammatory rebound upon early cessation of colchicine therapy, leading to increase left ventricular injury and subsequent thrombosis (30).…”

Colchicine efficacy comparison at varying time points in the peri-operative period for coronary artery disease: a systematic review and meta-analysis of randomized controlled trials

“…The age, gender, and underlying diseases of the two groups' baseline data were mostly comparable and consistent. Two of these studies used colchicine preoperatively (21,22); Five studies used colchicine in the postoperative period (23)(24)(25)(26)(27); Five studies used colchicine both pre-and postoperatively for PCI (28)(29)(30)(31)(32). details are shown in Tables 1, 2.…”