AHA 2019 — Colchicine lowers risk for further cardiovascular events post-MI


  • Daniel M. Keller, Ph.D
  • Conference Reports
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Takeaway

  • For patients with recent myocardial infarction (MI), colchicine reduced risk for first (23%) and total ischemic cardiovascular (CV) events (34%) vs placebo.

Why this matters

  • Inflammation contributes to atherosclerosis and its complications.
  • Colchicine is an oral, widely available, potent anti-inflammatory drug, now shown to reduce risk for atherosclerotic events after recent MI.

Study design

  • Patients ≤30 days post-MI receiving statins and antiplatelet agents (±other drugs).
  • Groups well matched for age (60.5 years), demographics, CV history, time post-MI to randomization (13.5 days), medications.
  • Percutaneous intervention completed if planned.
  • Randomly assigned to colchicine 0.5 mg/day (n=2366) or placebo (n=2379).
  • Canadian public funds and philanthropic foundations supported study.

Key results

  • Primary composite endpoint: Time to cardiovascular death, first resuscitated cardiac arrest, MI, stroke, or urgent coronary revascularization.
    • Follow-up, 42 months.
    • Colchicine, 5.5% vs placebo, 7.1% (HR, 0.77; 95% CI, 0.61-0.96; P=.02).
  • Statistically significant components of primary endpoint.
    • Stroke: 0.2% vs 0.8%, respectively (HR, 0.26; 95% CI, 0.10-0.70).
    • Urgent revascularization: 1.1% vs 2.1%, respectively (HR, 0.50; 95% CI, 0.31-0.81).
  • Colchicine reduced total (first and recurrent) primary endpoint events by 34%.
  • Low AE rates: no increased diarrhea with colchicine, but small increase in pneumonia, nausea, flatulence.

Limitations

  • Risks/benefits of treatment >23 months not evaluated.
  • Larger trial required to better assess individual endpoints, subgroups, risks.
  • Patients had recent MI; benefits of colchicine in other high-risk patients unknown.