Role of colchicine in reduction of no reflow phenomenon in patients with acute St-segment myocardial infarction undergoing primary percutaneous coronary intervention

Background: Acute STEMI remains a leading cause of mortality globally, with primary PCI being the standard reperfusion strategy. However, the no-reflow phenomenon, where coronary reperfusion is not achieved despite successful mechanical reopening, contributes to poor patient outcomes. Colchicine, a well-known anti-inflammatory agent, has been recently explored for its potential in reducing myocardial damage in STEMI patients. This study evaluates the efficacy of colchicine in reducing the no-reflow phenomenon in STEMI patients undergoing primary PCI. Methods: A total of 100 STEMI patients undergoing primary PCI at Ain Shams University Hospitals were enrolled. Participants were randomly allocated into two equal groups: the colchicine-treated group (n=50) and the control group (n=50). The colchicine group received 1 mg of colchicine at first medical contact and during PCI. The primary endpoints were TIMI flow score and MBG, assessed pre- and post-PCI. Results: The colchicine group demonstrated a significant improvement in TIMI flow (84% with TIMI 3 flow) compared to the control group (62% with TIMI 3 flow, P = 0.013). Furthermore, the colchicine group showed a higher percentage of MBG 3 (86%) compared to the control group (60%, P = 0.003). Conclusion: Pre-procedural colchicine loading markedly improved myocardial perfusion in STEMI patients undergoing primary PCI, as evidenced by enhanced TIMI flow and MBG. Colchicine may be a promising adjunctive therapy for reducing the no-reflow phenomenon and improving outcomes in STEMI patients.