Effect of Colchicine on Reducing Periprocedural Myocardial Injury Following Percutaneous Coronary Intervention in Patients with Coronary Artery Disease: A Randomized, Double-Blind, Placebo-Controlled Trial

Background: Percutaneous coronary intervention (PCI), while effective for coronary artery disease (CAD), frequently induces periprocedural myocardial injury (PMI), occurring in 25–70% of patients. Colchicine, a potent anti-inflammatory agent targeting the NLRP3 inflammasome and tubulin polymerization, has demonstrated cardioprotective properties in large-scale trials. However, its efficacy in attenuating PCI-related myocardial injury remains controversial. Objective: To evaluate the effect of a pre-procedural colchicine regimen (administered 12–24 hours before PCI) on reducing periprocedural myocardial injury, as assessed by cardiac troponin elevation, in patients with stable angina, unstable angina, and non-ST-elevation myocardial infarction (NSTEMI) undergoing coronary angioplasty. Methods: This single-center, randomized, double-blind, placebo-controlled trial enrolled 210 consecutive patients undergoing elective or urgent PCI at Shahid Madani Heart Hospital, Khorramabad, Iran (2024). Patients were randomized (1:1, block randomization) to receive either colchicine (1 mg 12–24 hours pre-procedure, 0.5 mg one hour pre-procedure, and 0.5 mg 30 minutes post-procedure; n = 105) or matching placebo (n = 105). The primary endpoint was the change in quantitative cardiac troponin levels from baseline to 24 hours post-PCI. Secondary endpoints included the incidence of PMI (troponin rise >1-fold but <5-fold baseline), periprocedural myocardial infarction (PMI; ≥5-fold troponin elevation), procedural characteristics, and safety outcomes. Subgroup analyses were performed by clinical presentation, diabetes status, and prior revascularization history. Results: Baseline demographic characteristics, cardiovascular risk factors, medication profiles, and procedural variables were well-balanced between groups (all p > 0.05). Mean pre-procedural troponin levels were comparable (colchicine: 0.39 ± 2.18 ng/mL vs. control: 0.29 ± 1.48 ng/mL; p = 0.696). Post-procedural troponin levels at 24 hours showed no significant between-group difference (1.32 ± 3.73 vs. 1.22 ± 3.73 ng/mL; p = 0.846). No significant differences were observed in contrast volume, stent parameters, balloon inflation characteristics, vascular access sites, or procedural complications (dissection, no-reflow: 0% in both groups). Subgroup analyses by clinical presentation (NSTE-ACS vs. stable angina), diabetes mellitus, and prior PCI/CABG history revealed no significant treatment–subgroup interactions. No serious adverse events attributable to colchicine were reported. Conclusions: In this randomized controlled trial, a pre-procedural colchicine regimen administered 12–24 hours before PCI did not significantly reduce periprocedural myocardial injury markers compared to placebo in patients with CAD. The absence of benefit may be attributable to the use of conventional (non-high-sensitivity) troponin assays, the relatively homogeneous study population, and advances in contemporary PCI techniques. Future multicenter trials employing high-sensitivity troponin assays, larger sample sizes, and diverse ethnic populations are warranted to definitively establish colchicine’s role in PCI-related cardioprotection.