Colchicine use in Acute Myocardial Infarction

Over the past years, there has been emerging evidence suggesting that inflammation plays a key role in ischemia/reperfusion-related injury in patients presenting with ST-elevation myocardial infarction (STEMI). However, little venture out to examine if this is possible in a clinical setting due to the lack of anti-inflammatory agents with favourable cardiovascular safety profiles. Colchicine, typically prescribed for the treatment of gout, displays potent anti-inflammatory properties but also allows for safe use in patients with cardiovascular disease. Recent studies have shown a short course of treatment with colchicine could lead to reduced major adverse cardiovascular events in acute myocardial infarction.

The New England Journal of Medicine conducted a double-blinded study to test if a short course of treatment with colchicine could lead to a reduction in atherosclerosis and its complications. The study titled COLCOT enrolled a total of 4745 patients, of which 2366 patients were assigned to the colchicine group. They received low dose colchicine of 0.5mg once daily. They were followed for a median of 22.6 months. The study concluded that patients assigned to the colchicine group had a significantly lower risk of ischemic cardiovascular events than the placebo group.

The primary end point of this study shows the possible benefit of low dose colchicine in patients with confirmed acute myocardial infarction. However, the COLCOT study also highlighted the increased report in diarrhoea and pneumonia, 9.7% vs 8.9% and 0.9% vs 0.4% respectively. Health professionals should exercise caution when prescribing colchicine and consider the possibility of polypharmacy and adding to the already large amount of medication prescribed post-myocardial infarction.