The effect of colchicine on myocardial infarction: An updated systematic review and meta-analysis of randomized controlled trials

Abstract

: Myocardial infarction (MI) is associated with a significant post-event inflammatory response which also contributes to post-MI prognosis. Colchicine, an anti-inflammatory agent, has exhibits potential benefits in various cardiovascular conditions such as coronary artery disease, pericarditis and atrial fibrillation. This meta-analysis predominantly aimed to provide an up-to-date evaluation of the efficacy and safety of colchicine in reducing adverse cardiovascular events in patients following acute MI. : A Systematic and comprehensive search was conducted on PubMed, Cochrane Library, Scopus, Google Scholar and clinicaltrials.gov for randomized controlled trials (RCTs) investigating the effect of colchicine on patients with MI until May 2024. Our primary outcome was a composite of adverse cardiovascular events, while secondary outcomes included all-cause mortality, incidence of stroke, cardiac arrest, hospitalization urgency, adverse gastrointestinal events and levels of high-sensitivity C - reactive protein (Hs-CRP). Risk ratios (RR) and standardized mean differences (SMD) were pooled under the random-effects model. : Eleven trials with 7161 patients were included in our analysis out of which 3546 (49.51%) were allocated to colchicine and 3591 (50.14%) received placebo. Colchicine demonstrated statistically significant reduction in the composite of adverse cardiovascular events (RR=0.75, 95% CI: 0.60-0.94, P=0.01, I 2 = 48%), hospitalization urgency (RR=0.46, 95% CI: 0.31-0.68, P=0.0001, I 2 =0%) and levels of Hs-CRP (SMD= -0.43, 95% CI:-0.83—0.03, P=0.03, I 2 =85%) but statistically significant increment in adverse gastrointestinal events (RR=1.86, 95% CI: 1.14-3.02, P=0.01, I 2 =79%). However, all-cause mortality (RR =1.00, 95% CI: 0.72-1.39, P=0.98, I 2 =0%), cardiac arrest (RR=0.81, 95% CI: 0.33-1.95, P=0.63, I 2 =0), incidence of stroke (RR=0.45, 95% CI: 0.17-1.19, P=0.11, I 2 =36%) and recurrent MI (RR=0.78, 95% CI: 0.57-1.06, P=0.11, I 2 =11%) remained comparable across the two groups. : The use of colchicine post-MI reduces the composite of adverse cardiovascular events, levels of Hs-CRP, hospitalization urgency but increases adverse gastrointestinal events. However, colchicine does not impact all-cause mortality, cardiac arrest, stroke incidence and incidence of recurrent MI. Large scale multicenter RCTs especially with longer follow-up duration are warranted to validate these findings Central Illustration highlighting key findings on effect of colchicine on patients with myocardial infarction

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