BACKGROUND: Experimental and clinical evidence supports the role of inflammation in atherosclerosis and its complications. Colchicine is an orally administered, potent antiinflammatory medication that is indicated for the treatment of gout and pericarditis. METHODS: We performed a randomized, double-blind trial involving patients recruited within 30 days after a myocardial infarction. The patients were randomly assigned to receive either low-dose colchicine (0.5 mg once daily) or placebo. The primary efficacy end point was a composite of death from cardiovascular causes, resuscitated cardiac arrest, myocardial infarction, stroke, or urgent hospitalization for angina leading to coronary revascularization. The components of the primary end point and safety were also assessed. RESULTS: A total of 4745 patients were enrolled; 2366 patients were assigned to the colchicine group, and 2379 to the placebo group. Patients were followed for a median of 22.6 months. The primary end point occurred in 5.5% of the patients in the colchicine group, as compared with 7.1% of those in the placebo group (hazard ratio, 0.77; 95% confidence interval [CI], 0.61 to 0.96; P = 0.02). The hazard ratios were 0.84 (95% CI, 0.46 to 1.52) for death from cardiovascular causes, 0.83 (95% CI, 0.25 to 2.73) for resuscitated cardiac arrest, 0.91 (95% CI, 0.68 to 1.21) for myocardial infarction, 0.26 (95% CI, 0.10 to 0.70) for stroke, and 0.50 (95% CI, 0.31 to 0.81) for urgent hospitalization for angina leading to coronary revascularization. Diarrhea was reported in 9.7% of the patients in the colchicine group and in 8.9% of those in the placebo group (P = 0.35). Pneumonia was reported as a serious adverse event in 0.9% of the patients in the colchicine group and in 0.4% of those in the placebo group (P = 0.03). CONCLUSIONS: Among patients with a recent myocardial infarction, colchicine at a dose of 0.5 mg daily led to a significantly lower risk of ischemic cardiovascular events than placebo. (Funded by the Government of Quebec and others; COLCOT ClinicalTrials.gov number, NCT02551094.).

From the Montreal Heart Institute all in France

N Engl J Med. 2019 Dec 26;381(26):2562-2563. doi: 10.1056/NEJMe1914378. PubMed

Nat Rev Cardiol. 2020 Feb;17(2):70-71. doi: 10.1038/s41569-019-0323-x. PubMed

MMW Fortschr Med. 2020 Mar;162(5):32. doi: 10.1007/s15006-020-0254-9. PubMed

Ann Intern Med. 2020 Apr 21;172(8):JC39. doi: 10.7326/ACPJ202004210-039. PubMed

N Engl J Med. 2020 Apr 23;382(17):1666-1667. doi: 10.1056/NEJMc2001194. PubMed

N Engl J Med. 2020 Apr 23;382(17):1667. doi: 10.1056/NEJMc2001194. PubMed

N Engl J Med. 2020 Apr 23;382(17):1667-1668. doi: 10.1056/NEJMc2001194. PubMed

References provided by Crossref.org

Editorial: The individualization of antiplatelet therapy in coronary artery disease: escalation or de-escalations

Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions

Cost-effectiveness of low-dose colchicine after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT)

Colchicine for prevention of vascular inflammation in Non-CardioEmbolic stroke (CONVINCE) - study protocol for a randomised controlled trial

See more in PubMed

ClinicalTrials.gov
NCT02551094