Effect of low‐dose colchicine in acute and chronic coronary syndromes: A systematic review and meta‐analysis

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.