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Colchicine and Prior Acute Coronary Syndrome
Quick Takes
- Patients with a history of very remote acute coronary syndrome (ACS) remain at high risk of recurrent MACE.
- The efficacy of colchicine in patients with chronic coronary disease appears independent of prior ACS status, producing consistent benefits irrespective of time since the most recent ACS event.
- Furthermore, the data underscore the importance of compliance with long-term guideline-directed therapies after ACS, which may include the use of anti-inflammatory therapy.
Study Questions:
What is the risk for major adverse cardiovascular events (MACE) in relation to history and timing of prior acute coronary syndrome (ACS), and are the benefits of colchicine consistent independent of prior ACS status?
Methods:
The investigators used the LoDoCo2 trial dataset to assess the risk for MACE based on prior ACS status. The LoDoCo2 (Low Dose Colchicine for Secondary Prevention of Cardiovascular Disease 2) trial randomly allocated patients with chronic coronary disease to colchicine 0.5 mg once daily or placebo. The rate of the composite of cardiovascular death, spontaneous myocardial infarction, ischemic stroke, or ischemia-driven coronary revascularization was compared between patients with no prior, recent (6-24 months), remote (2-7 years), or very remote (>7 years) ACS; interaction between ACS status and colchicine treatment effect was assessed. Cumulative event rates following randomization were plotted by treatment group using the Kaplan-Meier method and according to prior ACS status. Cox proportional hazards models were used to investigate colchicine treatment effect in each subgroup for the primary composite endpoint.
Results:
In 5,522 randomized patients, risk of the primary endpoint was independent of prior ACS status. Colchicine consistently reduced the primary endpoint in patients with no prior ACS (incidence: 2.8 vs 3.4 events per 100 person-years; hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.52-1.27), recent ACS (incidence: 2.4 vs. 3.3 events per 100 person-years; HR, 0.75; 95% CI, 0.51-1.10), remote ACS (incidence: 1.8 vs. 3.2 events per 100 person-years; HR, 0.55; 95% CI, 0.37-0.82), and very remote ACS (incidence: 3.0 vs, 4.3 events per 100 person-years; HR, 0.70; 95% CI, 0.51- 0.96) (p for interaction = 0.59).
Conclusions:
The authors concluded that the benefits of colchicine are consistent irrespective of history and timing of prior ACS.
Perspective:
This post hoc subgroup analysis of the LoDoCo2 trial reports that patients with a history of very remote ACS remain at high risk of recurrent MACE, and that the efficacy of colchicine in patients with chronic coronary disease appears independent of prior ACS status, producing consistent benefits irrespective of time since the most recent ACS event. These results from the LoDoCo2 trial suggest that the benefits of colchicine are consistent if started months or years after ACS. Furthermore, the data underscore the importance of compliance with long-term guideline-directed therapies, which may include the use of anti-inflammatory therapy.
Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Prevention, Cardiac Surgery and Arrhythmias, Interventions and ACS
Keywords: Acute Coronary Syndrome, Anti-Inflammatory Agents, Brain Ischemia, Colchicine, Coronary Disease, Inflammation, Myocardial Infarction, Myocardial Ischemia, Myocardial Revascularization, Primary Prevention, Risk Assessment, Secondary Prevention, Stroke, Vascular Diseases
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