Colchicine in Patients With Chronic Coronary Disease in Relation to Prior Acute Coronary Syndrome,Journal of the American College of Cardiology

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Colchicine in Patients With Chronic Coronary Disease in Relation to Prior Acute Coronary Syndrome
Journal of the American College of Cardiology ( IF 24.0 ) Pub Date : 2021-08-23 , DOI: 10.1016/j.jacc.2021.06.037
Tjerk S J Opstal ₁ , Aernoud T L Fiolet ₂ , Amber van Broekhoven ₃ , Arend Mosterd ₄ , John W Eikelboom ₅ , Stefan M Nidorf ₆ , Peter L Thompson ₇ , Michiel Duyvendak ₈ , J W Martijn van Eck ₉ , Eugène A van Beek ₁₀ , Frank den Hartog ₁₁ , Charley A Budgeon ₁₂ , Willem A Bax ₁₃ , Jan G P Tijssen ₁₄ , Saloua El Messaoudi ₃ , Jan H Cornel ₁₅ ,

Affiliation

Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Northwest Clinics, Alkmaar, the Netherlands.
Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Dutch Network for Cardiovascular Research, Utrecht, the Netherlands.
Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands.
Dutch Network for Cardiovascular Research, Utrecht, the Netherlands; Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Heart and Vascular Research Institute of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; GenesisCare Western Australia, Perth, Western Australia, Australia.
Heart and Vascular Research Institute of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia; University of Western Australia, Perth, Western Australia, Australia.
Department of Clinical Pharmacy, Antonius Hospital Sneek, Sneek, the Netherlands; Pharmacy D&A Research, Sneek, the Netherlands.
Department of Cardiology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.
Department of Cardiology, St Jansdal Hospital, Harderwijk, the Netherlands.
Department of Cardiology, Gelderse Vallei Hospital, Ede, the Netherlands.
University of Western Australia, Perth, Western Australia, Australia.
Department of Internal Medicine, Northwest Clinics, Alkmaar, the Netherlands.
Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Cardialysis BV, Rotterdam, the Netherlands.
Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Cardiology, Northwest Clinics, Alkmaar, the Netherlands; Dutch Network for Cardiovascular Research, Utrecht, the Netherlands.

Background

Colchicine reduces risk of cardiovascular events in patients post–myocardial infarction and in patients with chronic coronary disease. It remains unclear whether this effect is related to the time of onset of treatment following an acute coronary syndrome (ACS).

Objectives

This study investigates risk for major adverse cardiovascular events in relation to history and timing of prior ACS, to determine whether the benefits of colchicine are consistent independent of prior ACS status.

Methods

The LoDoCo2 (Low-Dose Colchicine 2) trial randomly allocated patients with chronic coronary disease to colchicine 0.5 mg once daily or placebo. The rate of the composite of cardiovascular death, spontaneous myocardial infarction, ischemic stroke, or ischemia-driven coronary revascularization was compared between patients with no prior, recent (6-24 months), remote (2-7 years), or very remote (>7 years) ACS; interaction between ACS status and colchicine treatment effect was assessed.

Results

In 5,522 randomized patients, risk of the primary endpoint was independent of prior ACS status. Colchicine consistently reduced the primary endpoint in patients with no prior ACS (incidence: 2.8 vs 3.4 events per 100 person-years; hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.52-1.27), recent ACS (incidence: 2.4 vs 3.3 events per 100 person-years; HR: 0.75; 95% CI: 0.51-1.10), remote ACS (incidence: 1.8 vs 3.2 events per 100 person-years, HR: 0.55; 95% CI: 0.37-0.82), and very remote ACS (incidence: 3.0 vs 4.3 events per 100 person-years, HR: 0.70; 95% CI: 0.51-0.96) (P for interaction = 0.59).

Conclusions

The benefits of colchicine are consistent irrespective of history and timing of prior ACS. (The LoDoCo2 Trial: Low Dose Colchicine for secondary prevention of cardiovascular disease [LoDoCo2] ACTRN12614000093684)

中文翻译：

与既往急性冠状动脉综合征相关的慢性冠状动脉疾病患者的秋水仙碱

背景

秋水仙碱可降低心肌梗死后患者和慢性冠状动脉疾病患者的心血管事件风险。尚不清楚这种影响是否与急性冠状动脉综合征 (ACS) 后开始治疗的时间有关。

目标

本研究调查了与既往 ACS 病史和时间相关的主要不良心血管事件风险，以确定秋水仙碱的益处是否与既往 ACS 状态无关。

方法

LoDoCo2（低剂量秋水仙碱 2）试验将慢性冠心病患者随机分配至每天一次 0.5 毫克秋水仙碱或安慰剂组。比较既往、近期（6-24 个月）、远期（2-7 年）或非常远期的患者之间心血管死亡、自发性心肌梗死、缺血性卒中或缺血驱动的冠状动脉血运重建的复合发生率。 >7 年）ACS；评估了 ACS 状态和秋水仙碱治疗效果之间的相互作用。

结果

在 5,522 名随机分组的患者中，主要终点的风险与既往 ACS 状态无关。秋水仙碱持续降低既往无 ACS 患者的主要终点（发生率：每 100 人年 2.8 与 3.4 次事件；风险比 [HR]：0.81；95% 置信区间 [CI]：0.52-1.27）、近期 ACS（发生率）：每 100 人年 2.4 与 3.3 次事件；HR：0.75；95% CI：0.51-1.10），远程 ACS（发生率：每 100 人年 1.8 与 3.2 次事件，HR：0.55；95% CI：0.827-0.827-1） ) 和非常远程的 ACS（发生率：每 100 人年 3.0 对 4.3 事件，HR：0.70；95% CI：0.51-0.96）（交互P = 0.59）。