Association of colchicine with cardiovascular outcomes in patients with acute coronary syndrome

Background While there has been significant evidence to implicate inflammation in the development of coronary artery disease, the association of colchicine use and its anti-inflammatory effects with risk of cardiovascular outcomes remains unclear. The current literature on colchicine use in the setting of non-ST Elevation myocardial infarctions (NSTEMI), ST Elevation myocardial infarctions (STEMI) has yielded conflicting results. Purpose We performed a systematic review and meta-analysis to evaluate the association between use of colchicine and cardiovascular outcomes in patients with ACS. Methods A literature search was performed using the databases Pubmed, Embase, and Web of Science, identifying studies that evaluated the association of colchicine with clinical endpoints in patients with ACS. Clinical endpoints of interest included all-cause mortality, cardiovascular (CV) mortality, development of congestive heart failure (CHF), recurrent acute myocardial infarction (AMI), and composite major adverse cardiovascular events (MACE). Randomized controlled trials and retrospective cohort studies were the primary sources of literature. The search was not restricted to time or publication status. Results A total of 16 studies with 28,129 ACS patients met inclusion criteria. 12,837 patients received colchicine, 15,302 patients did not receive colchicine. Mean follow up duration was 14.9 months, mean age was 61.4 years old, 80.3% of participants were men. Use of colchicine was associated with a significantly lower risk of MACE and AMI in the follow up period (OR 0.72, 95% CI 0.57–0.91; p=0.006; OR 0.78, 95% CI 0.65-0.92; p=0.004). Subgroup analysis demonstrated this association was primarily in patients with mixed ACS as no significant difference was noted in patients exclusively presenting with STEMI (OR 1.25, 95% CI 0.64 – 2.43; p=0.52 in STEMI patients). There was no difference in risk of all-cause mortality, CV mortality, or CHF in patients treated with or without colchicine (OR 0.95, 95% CI 0.74–1.22; p=0.70; OR 0.86, 95% CI 0.57–1.29; p=0.46; OR 0.93, 95% CI 0.49–1.75; p=0.82). Conclusions Use of colchicine is associated with significantly lower risk of MACE and AMI in patients with ACS, however this association may be dependent on type of ACS. There was no association between use of colchicine and lower risk of cardiac outcomes in patients presenting exclusively with STEMI. Additional high-quality studies are needed to further elucidate the utility of colchicine in patients with differing types of ACS.