Colchicine in the Management of Acute Coronary Syndrome: A Meta-analysis

INTRODUCTION: Colchicine, thought to exert its effect via reduction of inflammation, has recently been studied in patients following acute coronary syndromes (ACS). We performed a meta-analysis of all available randomized controlled trials (RCTs) in this high-risk cohort, evaluating efficacy and safety. METHODS: MEDLINE, PubMed, EMBASE, clinical trial registries, and select conference proceedings were searched for RCTs comparing colchicine to placebo in patients following ACS. The primary outcome was trial-defined major adverse cardiovascular events (MACE). Secondary endpoints included stroke, myocardial infarction (MI), all-cause and cardiovascular death, and urgent revascularization. Analysis was performed at the longest available clinical follow-up. RESULTS: Two RCTs with a pooled sample size of 5540 patients with 2778 (50.1%) receiving colchicine and 2762 (49.9%) placebo were included. In order to maximize consistency, composite efficacy endpoints between trials were modified. Compared to placebo, patients receiving colchicine had reduction in study-defined composite endpoint (5.5% vs. 7.6%) OR 0.67 (95% CI 0.46–0.98, p = 0.04, I(2) = 46%). Similarly, there was a significant reduction in cerebrovascular accidents (OR 0.31, 95% CI 0.14–0.69, p = 0.004, I(2) = 0%) and repeat revascularization OR 0.36 (95% CI 0.14–0.90, p = 0.03, I(2) = 54%). There was no difference between cardiovascular death (OR 0.92, 95% CI 0.52–1.62, p = 0.78, I(2) = 0%), non-cardiovascular death OR 1.27 (95% CI 0.72–2.24, p = 0.41, I(2) = 0%), MI at longest available follow-up OR 0.89 (95% CI 0.67–1.17, p = 0.39, I(2) = 0%) or resuscitated cardiac arrest OR 0.88 (95% CI 0.32–2.43, p = 0.81, I(2) = 0%) in those receiving colchicine. CONCLUSIONS: These data suggest colchicine, in addition to guideline-directed medical therapy following acute coronary syndrome reduces MACE, cerebrovascular accidents, and rates of urgent revascularization at 2 years of follow-up. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40119-022-00298-y.