Key result
Colchicine provides consistent relative major cardiovascular events reduction across ASCVD risk tiers, with greater absolute benefit in higher-risk patients.
Why the study?
Does colchicine 0.5 mg reduce MACE in patients with non-severe non-cardioembolic ischaemic stroke/TIA across different ASCVD risk categories?
RCT (n=3,144)
randomised
Does colchicine 0.5 mg reduce MACE in patients with non-severe non-cardioembolic ischaemic stroke/TIA across different ASCVD risk categories?
Answers are grounded in this paper and cite their sources.
While colchicine's relative efficacy did not significantly differ by baseline ASCVD risk, patients with very high risk may derive greater absolute benefit for secondary prevention after non-cardioembolic stroke.
Introduction The Colchicine for prevention of vascular inflammation in Non-CardioEmbolic stroke (CONVINCE) trial showed that recurrent events were significantly reduced among colchicine-adherent non-cardioembolic stroke patients in the on-treatment analysis. This study aimed to validate the SMART-REACH risk score in stroke patients, and to determine whether colchicine’s efficacy varies by baseline atherosclerotic cardiovascular disease (ASCVD) risk. Patients and methods Patients with non-severe non-cardioembolic ischaemic stroke/transient ischaemic attack (TIA) were randomised to colchicine 0.5 mg plus usual care or usual care alone. Participants were stratified into moderate (10%–19%), high (20%–30%) and very high (≥30%) 10-year ASCVD risk categories using the SMART-REACH model. Model performance was assessed using the C-statistic and calibration plots. The primary endpoint (major adverse cardiovascular events [MACE]) was a composite of fatal or non-fatal recurrent ischaemic stroke, myocardial infarction, cardiac arrest or hospitalisation for unstable angina. Results Among 3144 patients, MACE incidence significantly increased with ASCVD risk levels: 7.2% (moderate), 8.8% (high) and 13.8% (very high) (P < .01). The C-statistic for 3-year risk of MACE was 0.59 (95% CI, 0.56–0.63). While no statistically significant treatment interaction was found (P = .88), absolute risk reductions (ARRs) were more pronounced in higher-risk groups: moderate risk 7.2% (colchicine) vs 7.2% (usual care) (hazard ratio [HR] 1.01; 95% CI, 0.55–1.83); high risk 7.7% vs 9.8% (ARR 2.1%; HR 0.79; 95% CI, 0.53–1.18); very high risk 12.5% vs 15.2% (ARR 2.7%; HR 0.85; 95% CI, 0.64–1.12). Discussion and Conclusion We identified an association between very high baseline ASCVD risk (≥30%) assigned by the SMART-REACH score and increased recurrent MACE. Although no significant treatment interaction was observed, patients in higher risk categories may represent a more promising target population for secondary prevention with colchicine. Trial Registration ClinicalTrials.gov Identifier: NCT02898610.
No takes yet. Share an insight, caveat, or question.
Maes et al. (2026) conducted an RCT in non-severe non-cardioembolic ischaemic stroke/transient ischaemic attack (TIA) (n=3,144). colchicine vs. usual care alone was evaluated on major adverse cardiovascular events [MACE] (composite of fatal or non-fatal recurrent ischaemic stroke, myocardial infarction, cardiac arrest or hospitalisation for unstable angina). Colchicine did not show a significant treatment interaction by ASCVD risk for major cardiovascular events, though absolute risk reductions were larger in higher-risk groups.
Synapse has enriched 10 related papers. Consider them for comparative context: