Abstract Introduction Acute coronary syndrome (ACS) continues to be a global health challenge despite advancements in treatment strategies. European Society of Cardiology (ESC) has recommended low-dose colchicine in patients with chronic coronary syndrome. However, existing studies present conflicting evidence regarding its efficacy in ACS. Purpose This systematic review and meta-analysis aimed to assess the impact of colchicine on cardiovascular outcomes in individuals with ACS. Methods Online databases of PubMed, Embase, and the Cochrane Library were systematically searched for randomized controlled trials (RCTs) evaluating the effects of colchicine in patients following ACS from inception to November 2024. The primary endpoint was all-cause mortality. Secondary endpoints included cardiovascular mortality, stroke, myocardial infarction (MI), major adverse cardiovascular events (MACE), coronary revascularization, and gastrointestinal (GI) adverse events. The outcomes were obtained for the longest available follow-up. A Meta-analysis was then conducted using R software, with random-effects models estimating pooled risk ratios (RRs) to assess the effect of colchicine on the outcomes. Study quality was assessed using the Cochrane Risk of Bias-2 (RoB-2) tool. Results 12 RCTs comprising a total of 13,240 patients, 7,115 participants receiving colchicine and 6,125 participants receiving either a placebo or no additional treatment in conjunction with standard ACS management, were included. Meta-analysis revealed that colchicine did not significantly reduce all-cause mortality (RR 0.95, 95% CI 0.79–1.14) or cardiovascular mortality (RR 1.03, 95% CI 0.82–1.29) in patients with ACS. Additionally, colchicine did not show any significant effects on MACE (RR 0.74, 95% CI 0.50–1.09), MI (RR 0.87, 95% CI 0.72–1.05), revascularization (RR 0.60, 95% CI 0.30–1.19), or stroke (RR 0.62, 95% CI 0.29–1.31). The risk of GI adverse events was similarly not significantly increased (RR 1.48, 95% CI 0.99–2.21). Conclusion Our study suggests that colchicine does not show significant cardiovascular benefits in ACS patients. Further research should explore alternative anti-inflammatory approaches for ACS management.
Hosseini et al. (Sat,) studied this question.