Colchicine and cardiovascular outcomes in MINOCA: A retrospective cohort study

MINOCA accounts for 5 %-15 % of myocardial infarctions and is defined by <50 % coronary stenosis without an alternative diagnosis, with heterogeneous mechanisms that complicate care. Given the role of inflammation and microvascular dysfunction, we evaluated whether colchicine improves outcomes.

We conducted a retrospective cohort study using TriNetX, a federated health research network of 134 million patients from 102 healthcare organizations. Adults (≥18 years) with a primary diagnosis of acute myocardial infarction (AMI) and no revascularization after cardiac catheterization and without alternative diagnosis of elevated troponin were classified as MINOCA according to AHA criteria. Patients with MINOCA on colchicine (≥1 year of use for any indication) were propensity score matched with patients who were not on colchicine.

The primary composite outcome defined as AMI recurrence, all-cause mortality, cerebrovascular events, and all-cause hospitalizations, was significantly lower with colchicine (HR 0.839, 95 % CI 0.750-0.938, p < 0.001). Secondary outcomes of AMI recurrence (HR 0.749, 95 % CI 0.646-0.867, p < 0.001) and all-cause mortality (HR 0.518, 95 % CI 0.312-0.862, p < 0.001) were significantly lower in the colchicine group. Heart failure events (HR 0.861, 95 % CI 0.723-1.026, p > 0.05) and all-cause hospitalizations (HR 0.892, 95 % CI 0.779-1.020, p = 0.764) showed a trend toward lower rates with colchicine, which was not statistically significant. There was no difference in cerebrovascular events between the two groups (HR 1.364, 95 % CI 0.638-2.914, p = 0.820).

In this large real-world cohort, there was a trend toward reduced cardiovascular outcomes in patients with MINOCA who were on colchicine. These findings support further prospective evaluation of colchicine in this understudied population.

A portion of this work was presented as a poster at the 2025 American College of Cardiology Annual Scientific Session (Abstract #1047-113) on March 29, 2025, but the full manuscript and supplementary material remain unpublished. All authors have reviewed and approved the submission and report no conflicts of interest.