Daily colchicine post-MI reduces strokes and recurrent hospitalizations for angina (COLCOT)

Reference

Tardif JC, Kouz S, Waters DD, et al. Efficacy and safety of low-dose colchicine after myocardial infarction. N Engl J Med 2019;381(26):2497-2505.

Synopsis

Post-MI inflammation may play a role in atherosclerosis and lead to an increased risk of recurrent cardiovascular events. In this trial, investigators evaluated the role of colchicine, an inexpensive anti-inflammatory medication, in lowering the risk of ischemic cardiovascular events in patients with recent MIs. Adults who had an MI within the last 30 days and had completed any planned revascularization procedures were randomized, using concealed allocation, to receive either colchicine 0.5 mg daily (n = 2366) or placebo (n = 2379). Those with severe heart failure, severe hepatic or renal disease, recent stroke, or recent coronary-bypass surgery were excluded (among others). The primary endpoint was a composite of death from cardiovascular causes, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina leading to coronary revascularization. The 2 groups were similar at baseline: mean age was 61 years, 19% were women, 30% were smokers, 20% had diabetes, and almost all were also treated with dual antiplatelet therapy and a statin. Median follow-up was 23 months and patients received the trial drug for a median of 19 months. Overall, 5.5% of patients in the colchicine group had a primary endpoint event as compared with 7.1% in the placebo group (hazard ratio [HR] 0.77; 95% CI 0.61 - 0.96; P = .02; number needed to treat [NNT] = 63). This result was primarily driven by a decrease in stroke (HR 0.26; 0.10 - 0.70; NNT = 167) and a decrease in urgent hospitalizations for angina leading to revascularization (HR 0.50; 0.31 - 0.81; NNT = 100). As far as adverse events, the colchicine group reported more nausea and flatulence than the control group. Additionally, the colchicine group had a slightly higher rate of pneumonia, although the incidence was quite low (0.9% vs 0.4%; P = .03).