Key result
Long-term colchicine fails to reduce mortality or major cardiovascular events versus standard care in ACS.
Why the study?
Colchicine has emerged as a potential secondary prevention strategy post-ACS, but the impact of long-term therapy compared to standard care on cardiovascular events required evaluation.
Does long-term colchicine therapy reduce major cardiovascular outcomes in post-ACS patients compared to standard care?
Meta-Analysis (n=12,812)
Double-blind
Randomized
Yes
Does long-term colchicine therapy reduce major cardiovascular outcomes in post-ACS patients compared to standard care?
Effect estimate: HR 1.01 (95% CI 0.76-1.35)
p-value: p=0.96
Long-term colchicine therapy does not confer a consistent reduction in major cardiovascular outcomes after acute coronary syndrome, primarily due to substantial heterogeneity across trials.
Cautions against routine colchicine use post-ACS due to high trial heterogeneity; challenges prior low.
Anti-inflammatory therapy, particularly colchicine, has emerged as a potential secondary prevention strategy post-acute coronary syndrome (ACS). This meta-analysis assessed the impact of long-term colchicine therapy (≥12 months) compared to standard care on cardiovascular events in post-ACS patients. A systematic search of PubMed, Cochrane, Scopus, and Web of Science was conducted on December 22, 2024, for randomized controlled trials (RCTs) comparing long-term (≥12 months) treatment with colchicine to standard care in ACS patients. Outcomes assessed included all-cause mortality, cardiovascular death, myocardial infarction (MI), ischemia-driven revascularization, and stroke. Three RCTs (COLCOT, COPS, and CLEAR SYNERGY) with 12,602 patients were included. Colchicine did not significantly reduce all-cause mortality [hazard ratio (HR) 1.01, 95% confidence interval (CI): 0.67-1.53; I2=54%], cardiovascular death (HR 1.01, 95% CI: 0.80-1.29; I2=0%), or MI (HR 0.86, 95% CI: 0.71-1.05; I2=0%). Ischemia-driven revascularization (HR 0.61, 95% CI: 0.30-1.21; I2=81%) and stroke (HR 0.55, 95% CI: 0.18-1.64; I2=75%) showed non-significant reductions with high heterogeneity. The composite outcome of cardiovascular death, MI, revascularization, or stroke was not significantly reduced (HR 0.80, 95% CI: 0.59-1.07; I2=73%). These findings suggest that long-term colchicine therapy did not confer a consistent reduction in major cardiovascular outcomes after ACS. The pooled results indicate an overall null effect; however, the substantial heterogeneity across trials limits the certainty of this conclusion. This analysis may prompt a reassessment of colchicine's preventive role in ACS. Future studies should aim to reduce heterogeneity through standardized protocols and follow-up reporting and to explore whether subgroups, such as patients with elevated inflammatory markers, may derive benefit.
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Pinheiro et al. (2025) conducted a meta-analysis in Acute coronary syndrome (n=12,812). Colchicine vs. Placebo or standard care was evaluated on All-cause mortality (HR 1.01, 95% CI 0.76-1.35, p=0.96). Long-term colchicine therapy did not significantly reduce all-cause mortality (HR 1.01) or major cardiovascular outcomes compared to standard care in patients with acute coronary syndrome.
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