Colchicine in STEMI

Study Questions:

What is the impact of a short course of treatment with colchicine on infarct size in patients presenting with ST-segment elevation myocardial infarction (STEMI) and treated with primary percutaneous coronary intervention (PCI)?

Methods:

Patients presenting with STEMI 12 hours or less from pain onset (treated with primary PCI) were randomized to colchicine or placebo for 5 days. The primary outcome parameter was the area under the curve of creatine kinase-MB (CK-MB) concentration. A subset of patients underwent cardiac magnetic resonance imaging (MRI) with late gadolinium enhancement (LGE) 6-9 days after the index STEMI. Comparisons of central tendencies and correlations were tested using nonparametric tests (Mann-Whitney U and Spearman, respectively).

Results:

A total of 151 patients were included (60 in the MRI substudy). The area under the CK-MB curve was 3144 [interquartile range (IQR), 1754- 6940] ng.h.ml-1 in the colchicine group as compared to 6184 [IQR, 4456-6980] ng.h.ml-1 in controls (p < 0.001). Indexed MRI-LGE-defined infarct size was 18.3 [IQR, 7.6-29.9] ml/1.73 m2 in the colchicine group versus 23.2 [18.5-33.4] ml/1.73 m2 in controls (p = 0.019). The relative infarct size (as a proportion to left ventricular myocardial volume) was 13.0 [IQR, 8.0-25.3]% and 19.8 [IQR, 13.7-29.8]%, respectively (p = 0.034).

Conclusions:

The authors concluded that these results suggest a potential benefit of colchicine in STEMI.

Perspective:

This prospective randomized study appears to indicate that treatment with colchicine in patients with STEMI undergoing primary PCI is associated with smaller infarct size, as defined by both biomarker release and MRI-LGE. This effect was accompanied by a substantial treatment-related difference in markers of post-MI inflammatory response, namely neutrophil count and C-reactive protein. Adequately powered clinical trials with hard endpoints are indicated for definitive assessment since the present study was not powered to assess clinical endpoints.

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, ACS and Cardiac Biomarkers, Interventions and ACS, Interventions and Imaging, Magnetic Resonance Imaging

Keywords: Acute Coronary Syndrome, Biological Markers, C-Reactive Protein, Colchicine, Creatine Kinase, MB Form, Gadolinium, Magnetic Resonance Imaging, Myocardial Infarction, Neutrophils, Percutaneous Coronary Intervention


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