Clinical Use and Effectiveness of Colchicine for Secondary Prevention Following Acute Myocardial Infarction

Randomized controlled trials investigating colchicine for secondary prevention of cardiovascular events following acute myocardial infarction (AMI) have yielded conflicting results, and the real-world use and effectiveness of colchicine in this context remains unknown. As such, we sought to evaluate the use of colchicine following AMI in clinical practice and the associated outcomes. We performed a retrospective analysis of patients diagnosed with AMI and longitudinally followed in a large academic health system between 2018 and 2024 to describe the clinical use of colchicine for secondary prevention following AMI, as well as patient-level demographic and clinical characteristics associated with colchicine use. Next, using both multivariable logistic regression models with and without propensity matching, we examined the association between colchicine prescription following AMI and composite cardiovascular outcomes (comprised of recurrent AMI, any revascularization, stroke, and death). Kaplan-Meier Event-free Survival Analysis and Cox Proportional Hazards Models were performed. Of 1,796, 126 (7.0%) were prescribed colchicine after AMI. There was no association between use of colchicine and the composite cardiovascular events in either standard multivariable adjusted (Odds Ratio 1.00, 95% CI 0.66-1.50, p = 0.99) or propensity matched models (0.98, 0.57-1.66, p = 0.93). There was no difference in event-free survival between patients who were prescribed colchicine and those who were not. In summary, we report the first real-world data on the use and effectiveness of colchicine for prevention of cardiovascular events after AMI. Colchicine was infrequently prescribed for this indication and was not associated with lower rates of subsequent cardiovascular events.