Oral high-dose colchicine fails to reduce infarct size in patients with STEMI
High-dose oral colchicine during reperfusion and for 5 days failed to reduce infarct size in patients with STEMI presenting to hospital, according to a new study published in Circulation.
“Long-term colchicine treatment in patients with chronic coronary syndrome or the month after an acute coronary syndrome has recently been found to reduce the risk of major adverse cardiovascular events compared with placebo,” Nathan Mewton, MD, PhD, professor in cardiology and heart failure specialist at Louis Pradel Cardiovascular Hospital Clinical Investigation Center and Lyon and Claude Bernard University in Lyon, France, and colleagues wrote. “However, it is unclear whether short-term colchicine therapy given at the time of reperfusion reduces myocardial injury compared with placebo in patients with acute STEMI.”
The double-blind, multicenter, randomized, placebo-controlled trial included 192 patients admitted to the hospital for a first episode of STEMI referred for primary PCI. Patients were randomly assigned to oral colchicine at 2 mg as a loading dose followed by 0.5 mg twice per day (n = 101) or matching placebo (n = 91) from admission to day 5.
The primary outcome was infarct size evaluated by cardiac MRI at day 5. Secondary outcomes included relative LV end-diastolic volume change and infarct size at 3 months.
Mean infarct size was no different between patients who received colchicine and patients who received placebo (26 g vs. 28.4 g; P = .87). Researchers observed no significant difference in LV remodeling changes in LV end-diastolic volume between both groups (2.4% vs. –1.1%; P = .49) at 3 months. In addition, at 3 months, infarct size of LV mass was not significantly different between patients who received colchicine and patients who received placebo (17 g vs. 18 g, respectively; P = .92).
Incidence of gastrointestinal adverse events during the study was greater among those receiving colchicine compared with those receiving placebo (34% vs. 11%; P = .0002). However, at 3 months, there were 40 serious adverse events among patients who received colchicine and 32 serious adverse events among patients who received placebo (P = .66).
“Further studies exploring the timing, pharmacokinetics and dose response of colchicine and other anti-inflammatory agents are needed to identify an effective therapy to reduce infarct size or limit remodeling,” the researchers wrote.
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