Effect of Colchicine on Coronary Plaque Stability in Acute Coronary Syndrome as Assessed by Optical Coherence Tomography: The COLOCT Randomized Clinical Trial

BACKGROUND: Colchicine has been approved to reduce cardiovascular risk in patients with coronary heart disease on the basis of its potential benefits demonstrated in the COLCOT (Colchicine Cardiovascular Outcomes Trial) and LoDoCo2 (Low-Dose Colchicine 2) studies. Nevertheless, there are limited data available about the specific impact of colchicine on coronary plaques. METHODS: This was a prospective, single-center, randomized, double-blind clinical trial. From May 3, 2021, until August 31, 2022, a total of 128 patients with acute coronary syndrome aged 18 to 80 years with lipid-rich plaque (lipid pool arc >90°) detected by optical coherence tomography were included. The subjects were randomly assigned in a 1:1 ratio to receive either colchicine (0.5 mg once daily) or placebo for 12 months. The primary end point was the change in the minimal fibrous cap thickness from baseline to the 12-month follow-up. RESULTS: Among 128 patients, 52 in the colchicine group and 52 in the placebo group completed the study. The mean age of the 128 patients was 58.0±9.8 years, and 25.0% were female. Compared with placebo, colchicine therapy significantly increased the minimal fibrous cap thickness (51.9 95% CI, 32.8 to 71.0 μm versus 87.2 95% CI, 69.9 to 104.5 μm; difference, 34.2 95% CI, 9.7 to 58.6 μm; P =0.006), and reduced average lipid arc (–25.2° 95% CI, –30.6° to –19.9° versus –35.7° 95% CI, –40.5° to –30.8°; difference, –10.5° 95% CI, –17.7° to –3.4°; P =0.004), mean angular extension of macrophages (–8.9° 95% CI, –13.3° to –4.6° versus –14.0° 95% CI, –18.0° to –10.0°; difference, –6.0° 95% CI, –11.8° to –0.2°; P =0.044), high-sensitivity C-reactive protein level (geometric mean ratio, 0.6 95% CI, 0.4 to 1.0 versus 0.3 95% CI, 0.2 to 0.5; difference, 0.5 95% CI, 0.3 to 1.0; P =0.046), interleukin-6 level (geometric mean ratio, 0.8 95% CI, 0.6 to 1.1 versus 0.5 95% CI, 0.4 to 0.7; difference, 0.6 95% CI, 0.4 to 0.9; P =0.025), and myeloperoxidase level (geometric mean ratio, 1.0 95% CI, 0.8 to 1.2 versus 0.8 95% CI, 0.7 to 0.9; difference, 0.8 95% CI, 0.6 to 1.0; P =0.047). CONCLUSIONS: Our findings suggested that colchicine resulted in favorable effects on coronary plaque stabilization at optical coherence tomography in patients with acute coronary syndrome. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04848857.