AIMS: In the randomized, placebo-controlled Colchicine Cardiovascular Outcomes Trial (COLCOT) of 4745 patients enrolled within 30 days after myocardial infarction (MI), low-dose colchicine (0.5 mg once daily) reduced the incidence of the primary composite endpoint of cardiovascular death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina leading to coronary revascularization. To assess the in-trial period and lifetime cost-effectiveness of low-dose colchicine therapy compared to placebo in post-MI patients on standard-of-care therapy. METHODS AND RESULTS: A multistate Markov model was developed incorporating the primary efficacy and safety results from COLCOT, as well as healthcare costs and utilities from the Canadian healthcare system perspective. All components of the primary outcome, non-cardiovascular deaths, and pneumonia were included as health states in the model as both primary and recurrent events. In the main analysis, a deterministic approach was used to estimate the incremental cost-effectiveness ratio (ICER) for the trial period (24 months) and lifetime (20 years). Over the in-trial period, the addition of colchicine to post-MI standard-of-care treatment decreased the mean overall per-patient costs by 47%, from $502 to $265 Canadian dollar (CAD), and increased the quality-adjusted life years (QALYs) from 1.30 to 1.34. The lifetime per-patient costs were further reduced (69%) and QALYs increased with colchicine therapy (from 8.82 to 11.68). As a result, both in-trial and lifetime ICERs indicated colchicine therapy was a dominant strategy. CONCLUSION: Cost-effectiveness analyses indicate that the addition of colchicine to standard-of-care therapy after MI is economically dominant and therefore generates cost savings.
- MeSH
- analýza nákladů a výnosů MeSH
- infarkt myokardu * komplikace farmakoterapie MeSH
- kolchicin * terapeutické užití MeSH
- kvalitativně upravené roky života MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- Geografické názvy
- Kanada MeSH
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.).
- MeSH
- analýza podle původního léčebného záměru MeSH
- angina pectoris epidemiologie MeSH
- antiflogistika aplikace a dávkování škodlivé účinky MeSH
- biologické markery krev MeSH
- C-reaktivní protein analýza MeSH
- cévní mozková příhoda epidemiologie MeSH
- dvojitá slepá metoda MeSH
- incidence MeSH
- infarkt myokardu farmakoterapie terapie MeSH
- Kaplanův-Meierův odhad MeSH
- kardiovaskulární nemoci epidemiologie mortalita MeSH
- kolchicin aplikace a dávkování škodlivé účinky MeSH
- koronární angioplastika MeSH
- lidé středního věku MeSH
- lidé MeSH
- proporcionální rizikové modely MeSH
- recidiva MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
Nalezení pseudoaneurysmatu mezižeberní tepny během koronarografického vyšetření představuje vzácnou, avšak potenciálně smrtelnou komplikaci a vyžaduje zvláštní pozornost, aby bylo možno včas stanovit diagnózu. Popisujeme případ pacienta, u něhož se během vyšetření perkutánní koronarografií vytvořilo pseudoaneurysma mezižeberní tepny a který přežil díky rychle stanovené diagnóze, urgentní péči a důsledné monitoraci jeho stavu. Učební cíl: Zajistit, aby si lékař byl vědom možnosti takové komplikace, a byl tak schopen stanovit rychle diagnózu i poskytnout odpovídající léčbu.
Intercostal artery pseudoaneurysm during coronary angiography is a rare but potentially lethal complication that needs special attention in order to make the diagnosis on time. We report the case of a patient who developed intercostal artery pseudoaneurysm during percutaneous coronary angiography, and who survived thanks to a rapid diagnosis, urgent care and strict monitoring. Learning objective: Make the practitioner aware of such a complication in order to make a rapid diagnosis and an adequate management.
- MeSH
- arteriae thoracicae zranění MeSH
- endovaskulární výkony metody škodlivé účinky MeSH
- hemotorax MeSH
- koronární angiografie MeSH
- lidé MeSH
- nepravé aneurysma * diagnóza etiologie terapie MeSH
- poranění cév etiologie terapie MeSH
- poškození pacienta MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH