Colchicine not protective against AF, myocardial injury after noncardiac chest surgery
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Key takeaways:
- Colchicine after noncardiac chest surgery did not protect against perioperative atrial fibrillation or cardiac injury.
- A greater risk for noninfectious diarrhea was reported in the colchicine arm vs. placebo.
Colchicine did not reduce risk for perioperative atrial fibrillation or myocardial injury vs. placebo after noncardiac chest surgery, but a speaker noted a slight trend toward protection from a composite of both outcomes.
Colchicine after noncardiac thoracic surgery was associated with a significantly increased risk for mostly benign noninfectious diarrhea compared with placebo, but was otherwise safe, according to the results of the COP-AF trial presented at the European Society of Cardiology Congress.
David Conen, MD, MPH, associate professor of medicine at McMaster University in Hamilton, Ontario, Canada, and colleagues conducted the COP-AF trial to evaluate whether administration of the anti-inflammatory drug colchicine would reduce risk for perioperative AF and myocardial injury after noncardiac thoracic surgery.
The researchers enrolled 3,209 patients at 45 sites across 11 countries (mean age, 68 years; 52% men) undergoing noncardiac thoracic surgery and randomly assigned them to oral colchicine 0.5 mg or placebo. The drug was administered 4 hours before surgery and twice daily for 10 days. Study follow-up was 14 days.
The coprimary outcomes were clinically important AF — defined as AF or atrial flutter resulting in angina, HF, symptomatic hypotension or AF requiring treatment — and myocardial injury — defined as MI or elevated postoperative troponin due to myocardial ischemia.
The results of the COP-AF trial were simultaneously published in The Lancet.
Conen reported that although colchicine did not significantly reduce clinically important AF (HR = 0.85; 95% CI, 0.65-1.1; P = .22) or myocardial injury (HR = 0.89; 95% CI, 0.76-1.05; P = .16) individually, in post hoc analyses, there was a trend toward a significant reduction in a composite of the two outcomes (HR = 0.84; 95% CI, 0.73-0.97; P = .02) as well as a composite of vascular mortality, nonfatal myocardial injury and stroke and clinically important AF (HR = 0.83; 95% CI, 0.72-0.96; P = .01) compared with placebo.
The researchers observed no significant impact of colchicine on any other secondary or safety outcomes, with the exception of risk for noninfectious diarrhea, which was more than threefold higher among patients assigned to colchicine compared with those assigned placebo (HR = 3.64; 95% CI, 2.54-5.22; P < .001).
The diarrhea did not prolong patients’ hospitalization and led to just one hospital readmission, according to the presentation.
“Colchicine did not reduce the coprimary outcomes of clinically important AF and [myocardial injury],” Conan said during a press conference. “The increased risk of diarrhea in colchicine-treated patients was mostly transient and benign, and there was an encouraging trend of fewer cardiovascular events with colchicine that was in line with previous studies. We think that more studies are needed to evaluate the role of colchicine in patients undergoing surgery.”
Reference:
Conen D, et al. Lancet. 2023;doi:10.1016/S0140-6736(23)01689-6.
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Conen D, et al. Hot line 1. Presented at: European Society of Cardiology Congress; Aug. 25-28, 2023; Amsterdam (hybrid meeting).
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