Anti-Inflammatory Treatment With Colchicine in Acute Myocardial Infarction: A Pilot Study
Background—Inflammatory processes have been identified as key mediators of the deleterious effects of ischemia/reperfusion in ST-elevation myocardial infarction (STEMI). Colchicine is a substance with potent anti-inflammatory properties, suitable for safe use in patients with cardiovascular disease. The purpose of this study was to test the hypothesis that a short course of colchicine treatment could lead to reduced infarct size.
Methods and Results—Patients presenting with STEMI 12 hours or less from pain onset (treated with primary percutaneous coronary intervention) 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. 151 patients were included (60 in the MRI substudy). The area under the CK-MB curve was 3144 [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—These results suggest a potential benefit of colchicine in STEMI, but further clinical trials are necessary to draw secure conclusions, especially considering the fact that the present study was not powered to assess clinical endpoints.
Clinical Trial Registration Information—clinicaltrials.gov. Identifier: NCT01936285.
- Received May 20, 2015.
- Revision received August 4, 2015.
- Accepted August 5, 2015.