Alberto Aimo1,2, Domingo A Pascual Figal3,4,5, Antoni Bayes-Genis5,6, Michele Emdin1,2, Georgios Georgiopoulos7,8. 1. Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy. 2. Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy. 3. Cardiology Department, Virgen de la Arrixaca Hospital and School of Medicine, University of Murcia, Murcia, Spain. 4. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain. 5. CIBER Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain. 6. Hospital Universitari Germans Trias i Pujol, Badalona (Barcelona), Spain. 7. School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital Campus, London, UK. 8. Department of Clinical Therapeutics, National and Kapodistrian University of Athens School of Medicine, Athens, Greece.
Abstract
BACKGROUND: Sparse evidence of the prognostic benefit of the anti-inflammatory drug colchicine in chronic and acute coronary syndromes (CCS/ACS) exists. METHODS: We performed a systematic search of studies on CCS or ACS comparing colchicine vs. placebo and reporting data on cardiovascular outcomes (primary end points of each study) and/or changes in hs-CRP. RESULTS: Ten studies were selected: three on CCS (LoDoCo, LoDoCo2 and the CCS subgroup of COLCHICINE-PCI; total patient number = 6256), three on ACS (COLCOT, COPS, ACS subgroup of COLCHICINE-PCI; n = 5,654) and five (n = 532) on hs-CRP changes from 1 week to 12 months, in CCS and/or ACS. In patients with CCS, colchicine reduced by 49% risk of a composite end point (hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.32 to 0.81, P = .005). The favourable effect of colchicine on the risk of cardiovascular events did not change when excluding COLCHICINE-PCI from analysis (HR 0.51, 95% CI 0.25 to 1.03, P = .061). In patients with ACS, the use of colchicine tended to decrease the occurrence of the combined end point compared with placebo (HR = 0.77, 95% CI 0.56 to 1.05, P = .100), and colchicine became significantly protective when removing COLCHICINE-PCI from analysis (HR = 0.72, 95% CI 0.56 to 0.92, P = .009). Furthermore, colchicine tended to reduce the hs-CRP increase (standardized mean difference=-0.31, 95% CI -0.72 to 0.1, P = .133) compared with placebo. CONCLUSIONS: Colchicine therapy near halves the risk of cardiovascular events in CCS compared with placebo and is associated with a nonsignificant 23% risk reduction in ACS, together with a trend towards a greater reduction of hs-CRP.
BACKGROUND: Sparse evidence of the prognostic benefit of the anti-inflammatory drug colchicine in chronic and acute coronary syndromes (CCS/ACS) exists. METHODS: We performed a systematic search of studies on CCS or ACS comparing colchicine vs. placebo and reporting data on cardiovascular outcomes (primary end points of each study) and/or changes in hs-CRP. RESULTS: Ten studies were selected: three on CCS (LoDoCo, LoDoCo2 and the CCS subgroup of COLCHICINE-PCI; total patient number = 6256), three on ACS (COLCOT, COPS, ACS subgroup of COLCHICINE-PCI; n = 5,654) and five (n = 532) on hs-CRP changes from 1 week to 12 months, in CCS and/or ACS. In patients with CCS, colchicine reduced by 49% risk of a composite end point (hazard ratio [HR] 0.51, 95% confidence interval [CI] 0.32 to 0.81, P = .005). The favourable effect of colchicine on the risk of cardiovascular events did not change when excluding COLCHICINE-PCI from analysis (HR 0.51, 95% CI 0.25 to 1.03, P = .061). In patients with ACS, the use of colchicine tended to decrease the occurrence of the combined end point compared with placebo (HR = 0.77, 95% CI 0.56 to 1.05, P = .100), and colchicine became significantly protective when removing COLCHICINE-PCI from analysis (HR = 0.72, 95% CI 0.56 to 0.92, P = .009). Furthermore, colchicine tended to reduce the hs-CRP increase (standardized mean difference=-0.31, 95% CI -0.72 to 0.1, P = .133) compared with placebo. CONCLUSIONS:Colchicine therapy near halves the risk of cardiovascular events in CCS compared with placebo and is associated with a nonsignificant 23% risk reduction in ACS, together with a trend towards a greater reduction of hs-CRP.
Authors: Domingo A Pascual-Figal; Aychel E Roura-Piloto; Encarnación Moral-Escudero; Enrique Bernal; Helena Albendín-Iglesias; M Teresa Pérez-Martínez; Jose Antonio Noguera-Velasco; Iria Cebreiros-López; Álvaro Hernández-Vicente; David Vázquez-Andrés; Carmen Sánchez-Pérez; Amjad Khan; Fátima Sánchez-Cabo; Elisa García-Vázquez Journal: Int J Gen Med Date: 2021-09-11