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Effect of low‐dose colchicine in acute and chronic coronary syndromes: A systematic review and meta‐analysis
Author(s) -
Aimo Alberto,
Pascual Figal Domingo A.,
BayesGenis Antoni,
Emdin Michele,
Georgiopoulos Georgios
Publication year - 2021
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.13464
Subject(s) - colchicine , medicine , hazard ratio , placebo , conventional pci , confidence interval , subgroup analysis , gastroenterology , clinical endpoint , meta analysis , relative risk , myocardial infarction , randomized controlled trial , pathology , alternative medicine
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.