Waqas Ullah1, Shujaul Haq2, Salman Zahid3, Smitha Narayana Gowda4, Patrick Ottman2, Sameer Saleem5, Ihab Hamzeh6, Salim S Virani6,7, Mahboob Alam6, David L Fischman8. 1. Department of Medicine, Section of Cardiology, Thomas Jefferson University Hospitals, Philadelphia, PA, USA. waqasullah.dr@gmail.com. 2. Department of Internal Medicine, Abington Jefferson Health, Abington, PA, USA. 3. Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA. 4. Department of Internal Medicine, University of South Dakota, Vermillion, SD, USA. 5. Department of Medicine, Section of Cardiology, Medical Center Health, Bowling Green, KY, USA. 6. Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA. 7. Michael E. DeBakey Veterans Affairs Medical Center, Houston, USA. 8. Department of Medicine, Section of Cardiology, Thomas Jefferson University Hospitals, Philadelphia, PA, USA.
Abstract
BACKGROUND: Evidence from recent trials has shown conflicting results in terms of the utility of colchicine in patients with coronary artery disease (CAD). METHODS: Multiple databases were queried to identify all randomized controlled trials (RCTs) comparing the merits of colchicine in patients with acute coronary syndrome (ACS) or stable CAD. The pooled relative risk ratio (RR) of major adverse cardiovascular events (MACE), its components, and gastrointestinal (GI) adverse events were computed using a random-effect model. RESULTS: Ten RCTs comprising a total of 12,761 patients were identified. At a median follow-up of 12 months, there was a significantly lower risk of MACE [RR 0.66, 95% confidence interval (CI) 0.45-96], ACS (RR 0.66, 95% CI 0.45-0.96), ischemic stroke (RR 0.42, 95% CI 0.22-0.81), and need for revascularization (RR 0.61, 95% CI 0.42-90) in patients receiving colchicine compared with placebo. A subgroup analysis based on the clinical presentation showed that the significantly lower incidence of MACE and stroke were driven by the patients presenting with ACS. The use of colchicine in patients with stable CAD did not reduce the incidence of MACE (RR 0.55, 95% CI 0.28-1.09), ACS (RR 0.52, 95% CI 0.25-1.08), or stroke (RR 0.61, 95% CI 0.33-1.13). There was no significant difference in the relative risk of cardiac arrest, ACS, cardiovascular mortality, and all-cause mortality between the two groups in both ACS and stable CAD populations. The risk of GI adverse events was significantly higher in patients receiving colchicine (RR 2.10, 95% CI 1.12-3.95). CONCLUSION: In patients presenting with ACS, low-dose colchicine might reduce the incidence of MACE, stroke, and the need for revascularization at long follow-up durations. Colchicine might offer no benefits in reducing the risk of ischemic events in patients with stable angina.
BACKGROUND: Evidence from recent trials has shown conflicting results in terms of the utility of colchicine in patients with coronary artery disease (CAD). METHODS: Multiple databases were queried to identify all randomized controlled trials (RCTs) comparing the merits of colchicine in patients with acute coronary syndrome (ACS) or stable CAD. The pooled relative risk ratio (RR) of major adverse cardiovascular events (MACE), its components, and gastrointestinal (GI) adverse events were computed using a random-effect model. RESULTS: Ten RCTs comprising a total of 12,761 patients were identified. At a median follow-up of 12 months, there was a significantly lower risk of MACE [RR 0.66, 95% confidence interval (CI) 0.45-96], ACS (RR 0.66, 95% CI 0.45-0.96), ischemic stroke (RR 0.42, 95% CI 0.22-0.81), and need for revascularization (RR 0.61, 95% CI 0.42-90) in patients receiving colchicine compared with placebo. A subgroup analysis based on the clinical presentation showed that the significantly lower incidence of MACE and stroke were driven by the patients presenting with ACS. The use of colchicine in patients with stable CAD did not reduce the incidence of MACE (RR 0.55, 95% CI 0.28-1.09), ACS (RR 0.52, 95% CI 0.25-1.08), or stroke (RR 0.61, 95% CI 0.33-1.13). There was no significant difference in the relative risk of cardiac arrest, ACS, cardiovascular mortality, and all-cause mortality between the two groups in both ACS and stable CAD populations. The risk of GI adverse events was significantly higher in patients receiving colchicine (RR 2.10, 95% CI 1.12-3.95). CONCLUSION: In patients presenting with ACS, low-dose colchicine might reduce the incidence of MACE, stroke, and the need for revascularization at long follow-up durations. Colchicine might offer no benefits in reducing the risk of ischemic events in patients with stable angina.
Authors: Paul M Ridker; Brendan M Everett; Tom Thuren; Jean G MacFadyen; William H Chang; Christie Ballantyne; Francisco Fonseca; Jose Nicolau; Wolfgang Koenig; Stefan D Anker; John J P Kastelein; Jan H Cornel; Prem Pais; Daniel Pella; Jacques Genest; Renata Cifkova; Alberto Lorenzatti; Tamas Forster; Zhanna Kobalava; Luminita Vida-Simiti; Marcus Flather; Hiroaki Shimokawa; Hisao Ogawa; Mikael Dellborg; Paulo R F Rossi; Roland P T Troquay; Peter Libby; Robert J Glynn Journal: N Engl J Med Date: 2017-08-27 Impact factor: 91.245
Authors: Paul M Ridker; Brendan M Everett; Aruna Pradhan; Jean G MacFadyen; Daniel H Solomon; Elaine Zaharris; Virak Mam; Ahmed Hasan; Yves Rosenberg; Erin Iturriaga; Milan Gupta; Michelle Tsigoulis; Subodh Verma; Michael Clearfield; Peter Libby; Samuel Z Goldhaber; Roger Seagle; Cyril Ofori; Mohammad Saklayen; Samuel Butman; Narendra Singh; Michel Le May; Olivier Bertrand; James Johnston; Nina P Paynter; Robert J Glynn Journal: N Engl J Med Date: 2018-11-10 Impact factor: 91.245
Authors: Jean-Claude Tardif; Simon Kouz; David D Waters; Olivier F Bertrand; Rafael Diaz; Aldo P Maggioni; Fausto J Pinto; Reda Ibrahim; Habib Gamra; Ghassan S Kiwan; Colin Berry; José López-Sendón; Petr Ostadal; Wolfgang Koenig; Denis Angoulvant; Jean C Grégoire; Marc-André Lavoie; Marie-Pierre Dubé; David Rhainds; Mylène Provencher; Lucie Blondeau; Andreas Orfanos; Philippe L L'Allier; Marie-Claude Guertin; François Roubille Journal: N Engl J Med Date: 2019-11-16 Impact factor: 91.245