Preloading colchicine before PCI fails to help patients with acute MI
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Among patients with acute MI, a preloaded dose of colchicine before PCI did not prevent no-reflow phenomenon or improve clinical outcomes, according to results of the PodCAST-PCI trial.
As Healio previously reported, colchicine has been linked to a reduction in CV events in patients with MI in the COLCOT trial and in patients with chronic coronary disease in the LoDoCo2 trial. At the virtual Cardiovascular Research Technologies meeting, Yaser Jenab, MD, interventional cardiologist and associate professor of cardiology at Tehran Heart Center, Tehran University of Medical Sciences in Iran, said he and colleagues undertook the PodCAST-PCI study to see whether colchicine could also improve outcomes in patients with acute MI if administered before they underwent PCI.
“Activated neutrophils secrete neutrophil extracellular traps, which correlate with reperfusion injury and the final infarct size, and colchicine can suppress neutrophil extracellular trap formation in patients with ACS when administered after PCI,” Jenab said during a presentation. “Colchicine can also inhibit the adherence of neutrophils to the vascular endothelium and may improve microvascular rheology.”
The researchers enrolled 451 patients (mean age, 59 years; 79% men) in the randomized, double-blind, placebo-controlled trial, of whom 321 could be analyzed at 1 year. The colchicine group received a 1 mg oral tablet of colchicine just after randomization and a 0.5 mg tablet of colchicine 24 hours after the procedure, whereas the placebo group received matching placebos, Jenab said.
The primary endpoint of no-reflow phenomenon, defined as TIMI flow grade less than 3 after PCI or TIMI flow grade of 3 and TIMI myocardial perfusion grade of 0 or 1 after PCI, occurred in 14.4% of both groups (P = .098), Jenab said.
At 1 year, there was no difference between the groups in MACE, defined as target vessel revascularization, target lesion revascularization, new HF hospitalization, stroke, nonfatal MI or cardiac death (colchicine group, 9.3%; placebo group, 11.2%; HR = 0.87; 95% CI, 0.4-1.6; P = .54), according to the researchers.
High-sensitivity C-reactive protein increased less in the colchicine group than in the placebo group at 48 hours, but the difference was not significant, Jenab said during the presentation.
“Peak plasma levels of colchicine aren’t achieved until at least 1 hour after a loading dose of colchicine,” Binita Shah, MD, assistant professor of medicine and associate director of the cardiac cath lab research program at NYU Grossman School of Medicine, said during a discussion after the presentation. “With us moving so quickly in the primary PCI STEMI setting, it’s hard to imagine that a partial colchicine load prior to primary PCI would have had time to kick in and exert any evidence of its anti-inflammatory effects.”
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Jenab Y, et al. Landmark session: Late-breaking trials coronary. Presented at: Cardiovascular Research Technologies; Feb. 13-April 24, 2021 (virtual meeting).
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