June 21, 2023EP EuropaceOpen Access

Safety and efficacy of colchicine for the prevention of post-operative atrial fibrillation in patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials

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Why the study?

Colchicine may prevent post-operative atrial fibrillation, but its effect has been inconsistently shown in previous clinical trials.

Does colchicine prevent post-operative atrial fibrillation in patients undergoing cardiac surgery?

Structured PICO

Does colchicine prevent post-operative atrial fibrillation in patients undergoing cardiac surgery?

Population

1,885 patients undergoing cardiac surgery (pooled from 8 RCTs)

Intervention

Colchicine

Comparator

Placebo

Outcome

Incidence of post-operative atrial fibrillation (POAF) after any cardiac surgeryhard clinical

Colchicine effectively reduces the incidence of post-operative atrial fibrillation after cardiac surgery, though it increases the risk of gastrointestinal adverse events.

Implication

Colchicine prevents POAF after cardiac surgery but raises GI events; reinforces pooled RCT evidence while warranting GI monitoring.

Abstract

BACKGROUND AND AIMS: Colchicine is an anti-inflammatory drug that may prevent post-operative atrial fibrillation (POAF). The effect of this drug has been inconsistently shown in previous clinical trials. We aimed to compare the efficacy and safety of colchicine vs. placebo to prevent POAF in patients undergoing cardiac surgery. METHODS AND RESULTS: A systematic search of EMBASE, MEDLINE, SCOPUS, ClinicalTrials.gov, and the Cochrane Library for randomized controlled trials (RCTs) was conducted from inception till April 2023. The primary outcome was the incidence of POAF after any cardiac surgery. The secondary outcome was the rate of drug discontinuation due to adverse events and adverse gastrointestinal events. Risk ratios (RR) were reported using the Mantel Haenszel method. A total of eight RCTs comprising 1885 patients were included. There was a statistically significant lower risk of developing POAF with colchicine vs. placebo (RR: 0.70; 95% CI: 0.59-0.82; P < 0.01, I2 = 0%), and this effect persisted across different subgroups. There was a significantly higher risk of adverse gastrointestinal events (RR: 2.20; 95% CI: 1.38-3.51; P < 0.01, I2 = 55%) with no difference in the risk of drug discontinuation in patients receiving colchicine vs. placebo (RR: 1.33; 95% CI: 0.93-1.89; P = 0.11, I2 = 0%). CONCLUSION: This meta-analysis of eight RCTs shows that colchicine is effective at preventing POAF, with a significantly higher risk of adverse gastrointestinal events but no difference in the rate of drug discontinuation. Future studies are required to define the optimal duration and dose of colchicine for the prevention of POAF.