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Safety and Efficacy of Colchicine in Patients with Stable CAD and ACS: A Systematic Review and Meta-analysis

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Abstract

Background

Evidence from recent trials has shown conflicting results in terms of the utility of colchicine in patients with coronary artery disease (CAD).

Methods

Multiple databases were queried to identify all randomized controlled trials (RCTs) comparing the merits of colchicine in patients with acute coronary syndrome (ACS) or stable CAD. The pooled relative risk ratio (RR) of major adverse cardiovascular events (MACE), its components, and gastrointestinal (GI) adverse events were computed using a random-effect model.

Results

Ten RCTs comprising a total of 12,761 patients were identified. At a median follow-up of 12 months, there was a significantly lower risk of MACE [RR 0.66, 95% confidence interval (CI) 0.45–96], ACS (RR 0.66, 95% CI 0.45–0.96), ischemic stroke (RR 0.42, 95% CI 0.22–0.81), and need for revascularization (RR 0.61, 95% CI 0.42–90) in patients receiving colchicine compared with placebo. A subgroup analysis based on the clinical presentation showed that the significantly lower incidence of MACE and stroke were driven by the patients presenting with ACS. The use of colchicine in patients with stable CAD did not reduce the incidence of MACE (RR 0.55, 95% CI 0.28–1.09), ACS (RR 0.52, 95% CI 0.25–1.08), or stroke (RR 0.61, 95% CI 0.33–1.13). There was no significant difference in the relative risk of cardiac arrest, ACS, cardiovascular mortality, and all-cause mortality between the two groups in both ACS and stable CAD populations. The risk of GI adverse events was significantly higher in patients receiving colchicine (RR 2.10, 95% CI 1.12–3.95).

Conclusion

In patients presenting with ACS, low-dose colchicine might reduce the incidence of MACE, stroke, and the need for revascularization at long follow-up durations. Colchicine might offer no benefits in reducing the risk of ischemic events in patients with stable angina.

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Authors and Affiliations

  1. Department of Medicine, Section of Cardiology, Thomas Jefferson University Hospitals, Philadelphia, PA, USA

    Waqas Ullah & David L. Fischman

  2. Department of Internal Medicine, Abington Jefferson Health, Abington, PA, USA

    Shujaul Haq & Patrick Ottman

  3. Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA

    Salman Zahid

  4. Department of Internal Medicine, University of South Dakota, Vermillion, SD, USA

    Smitha Narayana Gowda

  5. Department of Medicine, Section of Cardiology, Medical Center Health, Bowling Green, KY, USA

    Sameer Saleem

  6. Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA

    Ihab Hamzeh, Salim S. Virani & Mahboob Alam

  7. Michael E. DeBakey Veterans Affairs Medical Center, Houston, USA

    Salim S. Virani

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  1. Waqas Ullah
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Correspondence to Waqas Ullah.

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Funding

To Salim S. Virani: research support was provided by the Department of Veterans Affairs, World Heart Federation, Tahir and Jooma Family Honorarium, and American College of Cardiology (Associate Editor for Innovations).

Conflict of interest

Waqas Ullah, Shujaul Haq, Salman Zahid, Smitha Narayana Gowda, Patrick Ottman, Sameer Saleem, Ihab Hamzeh, Salim S. Virani, Mahboob Alam, and David L. Fischman declare that they have no potential conflicts of interest that might be relevant to the contents of this article.

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Authors' contributions

WU: Conceptualization, analysis, and writing. SZ: Revision and quality assessment of articles. SH: Writing manuscript. SNG: Data collection and quality assessment. PO: Data collection. SS: Writing. IH: Critical review. SV: Critical review and editing. MA: Editing. DF: Supervision and critical review.

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Ullah, W., Haq, S., Zahid, S. et al. Safety and Efficacy of Colchicine in Patients with Stable CAD and ACS: A Systematic Review and Meta-analysis. Am J Cardiovasc Drugs 21, 659–668 (2021). https://doi.org/10.1007/s40256-021-00485-7

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