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The effect of colchicine on myocardial infarction: An updated systematic review and meta-analysis of randomized
Ayesha Younas1, Zainab Awan2, Tehreem Khan2
1Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan.
Insights
Colchicine use after myocardial infarction (MI) reduces cardiovascular events and urgent hospitalizations but increases gastrointestinal issues. It does not affect mortality or recurrent MI rates.
Area of Science:
- Cardiology
- Pharmacology
- Inflammation Research
Background:
- Myocardial infarction (MI) triggers significant post-event inflammation, impacting patient prognosis.
- Colchicine, an anti-inflammatory drug, shows promise in cardiovascular conditions like coronary artery disease and atrial fibrillation.
Purpose of the Study:
- To evaluate the efficacy and safety of colchicine in reducing adverse cardiovascular events in patients post-acute MI.
- To provide an updated meta-analysis of colchicine's impact on post-MI outcomes.
Main Methods:
- A comprehensive meta-analysis of randomized controlled trials (RCTs) was conducted.
- Searched databases including PubMed, Cochrane Library, Scopus, Google Scholar, and clinicaltrials.gov up to May 2024.
- Analyzed primary composite cardiovascular events and secondary outcomes like mortality, stroke, cardiac arrest, hospitalization urgency, recurrent MI, GI events, and hs-CRP levels.
Main Results:
- Colchicine significantly reduced composite adverse cardiovascular events (RR=0.75) and hospitalization urgency (RR=0.46).
- An increase in adverse gastrointestinal events was observed with colchicine use (RR=1.86).
- No significant differences were found in all-cause mortality, cardiac arrest, stroke, recurrent MI, or hs-CRP levels between colchicine and placebo groups.
Conclusions:
- Colchicine use post-MI effectively lowers adverse cardiovascular events and hospitalization urgency.
- Colchicine is associated with a higher incidence of gastrointestinal adverse events.
- Further large-scale, multicenter RCTs with extended follow-up are needed to confirm these findings.
Introduction:
Myocardial infarction (MI) is associated with a significant post-event inflammatory response which further contributes to post-MI prognosis. Colchicine, an anti-inflammatory agent, exhibits potential benefits in various cardiovascular conditions such as coronary artery disease, pericarditis and atrial fibrillation. This meta-analysis predominantly aimed to provide an up-to-date evaluation of the efficacy and safety of colchicine in reducing adverse cardiovascular events in patients following acute MI.
Methods:
A Comprehensive search was conducted on PubMed, Cochrane Library, Scopus, Google Scholar and clinicaltrials.gov for randomized controlled trials (RCTs) investigating the effect of colchicine on patients with MI from inception till May 2024. Our primary outcome was a composite of adverse cardiovascular events, while secondary outcomes included all-cause mortality, incidence of stroke, incidence of cardiac arrest, hospitalization urgency, incidence of recurrent MI, adverse gastrointestinal events and levels of high-sensitivity C - reactive protein (Hs-CRP). Risk ratios (RR) and mean differences (MD) were pooled under the random-effects model.
Results:
Eleven trials with 7161 patients were included in our analysis out of which 3546 (49.51 %) were allocated to colchicine and 3591 (50.14 %) received placebo. Colchicine demonstrated statistically significant reduction in the composite of adverse cardiovascular events (RR = 0.75, 95 % CI: 0.60-0.94, P = 0.01, I2 = 47 %), and hospitalization urgency (RR = 0.46, 95 % CI: 0.31-0.68, P = 0.0001, I2 = 0 %) but statistically significant increment in adverse gastrointestinal events (RR = 1.86, 95 % CI: 1.14-3.02, P = 0.01, I2 = 79 %). However, all-cause mortality (RR = 1.00, 95 % CI: 0.72-1.39, P = 0.98, I2 = 0 %), incidence of cardiac arrest (RR = 0.81, 95 % CI: 0.33-1.95, P = 0.63, I2 = 0), incidence of stroke (RR = 0.45, 95 % CI: 0.17-1.19, P = 0.11, I2 = 36 %), incidence of recurrent MI (RR = 0.78, 95 % CI: 0.57-1.06, P = 0.11, I2 = 11 %) and the levels of hs-CRP (MD= -0.87, 95 %CI: -1.80-0.06, P=0.07, I2=67 % remained comparable across the two groups.
Conclusion:
The use of colchicine post-MI reduces the composite of adverse cardiovascular events, and hospitalization urgency but increases adverse gastrointestinal events. However, colchicine does not impact all-cause mortality, cardiac arrest, stroke incidence, incidence of recurrent MI and the levels of hs-CRP. Large scale multicenter RCTs especially with longer follow-up duration are warranted to validate these findings.
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