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Efficacy and Safety of Colchicine in Reducing Reperfusion Injury Among Patients With ST-Segment Elevation Myocardial

Archana Dhami1, Bassel Abdul Latif El Ejel2, Mazhar Khalil3

  • 1Family Medicine, Avalon University School of Medicine, Willemstad, CUW.

Cureus
|October 7, 2025
PubMed

Insights

Colchicine did not significantly reduce ischemia-reperfusion injury in ST-elevation myocardial infarction (STEMI) patients undergoing PCI. The drug showed potential safety concerns, including increased thrombus formation, and did not offer clear cardioprotection.

Area of Science:

  • Cardiology
  • Pharmacology
  • Inflammation Research

Background:

  • Ischemia-reperfusion injury (IRI) is a significant complication following primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
  • Colchicine, an anti-inflammatory agent, has been investigated for its potential cardioprotective effects against IRI.

Purpose of the Study:

  • To systematically review the efficacy and safety of colchicine in mitigating IRI in STEMI patients undergoing primary PCI.
  • To evaluate colchicine's impact on infarct size, inflammatory markers, and major adverse cardiovascular events.

Main Methods:

  • A systematic literature search was conducted across five databases, identifying five studies with 390 patients.
  • Included studies were randomized controlled trials and prospective studies examining various colchicine dosing strategies.
  • Outcomes assessed included infarct size, inflammatory biomarkers, major adverse cardiovascular events, and safety.

Main Results:

  • Findings regarding colchicine's efficacy were heterogeneous, with some trends toward reduced inflammatory markers but no significant reduction in reperfusion injury or infarct size.
  • The COVERT-MI trial reported a threefold increase in left ventricular thrombus formation with colchicine, raising safety concerns.
  • Gastrointestinal side effects were consistently observed across the included studies.

Conclusions:

  • The anti-inflammatory effects of colchicine do not appear to translate into significant clinical cardioprotection during the acute phase of STEMI.
  • Current evidence does not support the routine use of colchicine for reducing reperfusion injury in STEMI patients undergoing primary PCI.
  • Larger, well-designed trials with standardized protocols are needed to definitively determine colchicine's role in acute myocardial infarction management.

Keywords:
colchicineinflammasomeischemia-reperfusionleft ventricular thrombusprimary percutaneous coronary interventionreperfusion injuryst-segment elevation myocardial infarction

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