Does oral colchicine given 6 to 24 hours before PCI prevent coronary microvascular dysfunction and periprocedural myocardial injury in patients undergoing PCI for stable angina or NSTEMI?
Preprocedural colchicine in PCI patients improves coronary microvascular physiology and reduces periprocedural myocardial injury, though it did not significantly reduce the binary definition of coronary microvascular dysfunction in this pilot study.
Aim. In this randomized pilot trial, we aimed to assess the anti-inflammatory effect of preprocedural colchicine on coronary microvascular physiology measurements before and after PCI. Methods. Patients undergoing PCI for stable angina (SA) or non-ST-elevation myocardial infarction (NSTEMI) were randomized to oral colchicine or placebo, 6- to 24-hours before the procedure. Strict prespecified inclusion/exclusion criteria were set to ensure all patients were given the study medication, had a PCI, and had pre- and post-PCI culprit vessel invasive coronary physiology measurements. Fractional flow reserve (FFR), Index of Microvascular Resistance (IMR), Coronary Flow Reserve (CFR), and Resistive Reserve Ratio (RRR) were measured immediately before and after PCI. CMVD was defined as any one of post-PCI IMR >32 or CFR p = 0.16 ). Colchicine patients had higher post-PCI CFR and RRR vs placebo (respectively: 3.25 vs 2.00, p = 0.03 & 4.25 vs 2.75, p 0.01 ). Neutrophil count was lower after PCI in the colchicine arm p = 0.02 , and hsCRP post-PCI remained low in both treatment arms (1.0 mg/L vs 1.7 mg/L, p = 0.97 ). Patients randomized to colchicine had significantly less PCI-related absolute hs-troponin-I change (46 ng/L vs 152 ng/L, p = 0.01 ). Conclusion. In this pilot randomized substudy, colchicine given 6 to 24 hours before PCI did not statistically impact the post-PCI CMVD definition used in this study, yet it did improve post-PCI RRR and CFR measurements, with less procedure-related troponin release and less inflammation.
Cole et al. (Sun,) studied this question.