Colchicine Among Patients with Acute Coronary Syndrome: A Meta-Analysis of Randomized Trials

Prior trials evaluating the benefit of colchicine in patients with acute coronary syndrome (ACS) have yielded mixed results. Hence, we conducted a meta-analysis of randomized controlled trials (RCTs) to evaluate the role of colchicine after ACS.

We performed an electronic search of MEDLINE, Embase, and Cochrane databases through November 2024 for studies comparing colchicine with placebo after ACS. Our study's primary outcome was major adverse cardiac events (MACE).

Our final analysis included five RCTs with 12,979 patients with a mean follow-up of 26.6 months. The weighted mean age was 59.8 years. Colchicine was associated with a modest reduction of MACE with marginal significance and high heterogeneity (7.3% vs. 8.3%; relative risk [RR] 0.73; 95% confidence interval [CI] 0.54-0.99; I² = 68%) compared with placebo. This benefit was inconsistent after excluding the study with higher heterogeneity. There was no significant difference between colchicine and placebo in all-cause mortality (3.4% vs. 3.5%; RR 1.04; 95% CI 0.71-1.53; I² = 43%), cardiac mortality (2.2% vs. 2.2%; RR 1.02; 95% CI 0.81-1.29; I² = 0), myocardial infarction (MI) (3.1% vs. 3.6%; RR 0.82; 95% CI 0.61-1.11; I² = 35%), ischemia-driven repeat revascularization (4.3% vs. 4.6%; RR 0.75; 95% CI 0.37-1.50; I² = 54%), and stroke (0.9% vs. 1.1%; RR 0.51; 95% CI 0.18-1.44; I² = 68%). Colchicine had a higher risk of gastrointestinal (GI) side effects (11.7% vs. 8.6%; RR 1.36; 95% CI 1.07-1.71; I² = 67%) compared with placebo.

Among patients with ACS, colchicine may modestly reduce the incidence of MACE compared with placebo, but this effect is not robust after excluding the study with a higher risk of bias. In addition, no significant benefits were observed for the main individual outcomes of MACE, including all-cause mortality, cardiac mortality, MI, ischemia-driven repeat revascularization and stroke. Yet, colchicine was associated with a higher risk of GI side effects.