From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.).
Circulation. 2015 Oct 13;132(15):1395-403. doi: 10.1161/CIRCULATIONAHA.115.017611. Epub 2015 Aug 11.
Inflammatory processes have been identified as key mediators of the deleterious effects of ischemia/reperfusion in ST-segment-elevation myocardial infarction. Colchicine is a substance with potent anti-inflammatory properties, suitable for safe use in patients with cardiovascular disease. The purpose of this study was to test the hypothesis that a short course of colchicine treatment could lead to reduced infarct size.
Patients presenting with ST-segment-elevation myocardial infarction ≤12 hours from pain onset (treated with primary percutaneous coronary intervention) were randomly assigned to colchicine or placebo for 5 days. The primary outcome parameter was the area under the curve of creatine kinase-myocardial brain fraction concentration. A subset of patients underwent cardiac MRI with late gadolinium enhancement 6 to 9 days after the index ST-segment-elevation myocardial infarction. One hundred fifty-one patients were included (60 in the MRI substudy). The area under the creatine kinase-myocardial brain fraction curve was 3144 (interquartile range [IQR], 1754-6940) ng·h(-1)·mL(-1) in the colchicine group in comparison with 6184 (IQR, 4456-6980) ng·h(-1)·mL(-1) in controls (P<0.001). Indexed MRI-late gadolinium enhancement-defined infarct size was 18.3 (IQR, 7.6-29.9) mL/1.73 m(2) in the colchicine group versus 23.2 (18.5-33.4) mL/1.73 m(2) in controls (P=0.019). The relative infarct size (as a proportion to left ventricular myocardial volume) was 13.0 (IQR, 8.0-25.3) % and 19.8 (IQR, 13.7-29.8) %, respectively (P=0.034).
These results suggest a potential benefit of colchicine in ST-segment-elevation myocardial infarction, but further clinical trials are necessary to draw secure conclusions, especially considering the fact that the present study was not powered to assess clinical end points.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01936285.
炎症过程已被确定为缺血/再灌注对 ST 段抬高型心肌梗死有害影响的关键介质。秋水仙碱是一种具有强大抗炎特性的物质，适用于心血管疾病患者的安全使用。本研究的目的是检验秋水仙碱短期治疗可导致梗死面积减少的假设。
胸痛发作后 12 小时内出现 ST 段抬高型心肌梗死的患者（接受直接经皮冠状动脉介入治疗）被随机分配接受秋水仙碱或安慰剂治疗 5 天。主要结局参数是肌酸激酶-心肌脑分馏浓度曲线下面积。一组患者在指数 ST 段抬高型心肌梗死后 6 至 9 天行心脏 MRI 检查，伴有晚期钆增强。共纳入 151 例患者（MRI 亚研究组 60 例）。秋水仙碱组肌酸激酶-心肌脑分馏曲线下面积为 3144（四分位距[IQR]，1754-6940）ng·h(-1)·mL(-1)，而对照组为 6184（IQR，4456-6980）ng·h(-1)·mL(-1）（P<0.001）。秋水仙碱组的 MRI 晚期钆增强定义的梗死面积为 18.3（IQR，7.6-29.9）mL/1.73 m(2)，而对照组为 23.2（18.5-33.4）mL/1.73 m(2)（P=0.019）。相对梗死面积（占左心室心肌体积的比例）分别为 13.0（IQR，8.0-25.3）%和 19.8（IQR，13.7-29.8）%（P=0.034）。
这些结果表明秋水仙碱对 ST 段抬高型心肌梗死可能有益，但需要进一步的临床试验来得出更确定的结论，特别是考虑到本研究没有足够的能力评估临床终点。
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