Colchicine in Patients With Coronary Artery Disease and Myocardial Infarction: A Narrative Review of Randomized Controlled Trials

Unstructured Abstract Colchicine has demonstrated consistent cardiovascular benefit in stable coronary artery disease (CAD) and pericarditis, yet its efficacy in the acute post-myocardial infarction (MI) setting remains uncertain. While prior meta-analyses have pooled results across relevant trials, they cannot examine the discrepancies in individual trial design and patient population that may explain these findings. This narrative review examines five major RCTs evaluating colchicine across the CAD and MI spectrum: the Low-Dose Colchicine (LoDoCo) trial, the Low-Dose Colchicine 2 (LoDoCo2) trial, the Colchicine Cardiovascular Outcomes Trial (COLCOT), the Colchicine in Patients with Acute Coronary Syndrome (COPS) trial, and the Colchicine and Spironolactone in Patients with Myocardial Infarction/Synergy Stent Registry (CLEAR). In stable CAD, colchicine consistently reduced cardiovascular events, with LoDoCo showing a 67% relative risk reduction (HR 0.33, 95% CI 0.18-0.59) and LoDoCo2 confirming a 31% reduction (HR 0.69, 95% CI 0.57-0.83). In the post-MI setting, results were mixed: COLCOT demonstrated a significant 23% reduction in its composite endpoint (HR 0.77, 95% CI 0.61-0.96), while COPS and CLEAR produced neutral results. Differences in baseline risk profiles, endpoint definitions, timing of initiation, and the inflammatory state of acute versus chronic coronary disease all contribute to the heterogeneity observed. Colchicine has an established role in stable CAD and its use is supported by current guidelines. Routine use after acute MI is not currently supported, and future trials examining on-treatment CRP response and optimized treatment strategies are needed to determine whether specific subgroups may benefit.