Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan.
Department of Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan.
Curr Probl Cardiol. 2025 Jan;50(1):102878. doi: 10.1016/j.cpcardiol.2024.102878. Epub 2024 Oct 10.
Myocardial infarction (MI) is associated with a significant post-event inflammatory response which further contributes to post-MI prognosis. Colchicine, an anti-inflammatory agent, exhibits potential benefits in various cardiovascular conditions such as coronary artery disease, pericarditis and atrial fibrillation. This meta-analysis predominantly aimed to provide an up-to-date evaluation of the efficacy and safety of colchicine in reducing adverse cardiovascular events in patients following acute MI.
A Comprehensive search was conducted on PubMed, Cochrane Library, Scopus, Google Scholar and clinicaltrials.gov for randomized controlled trials (RCTs) investigating the effect of colchicine on patients with MI from inception till May 2024. Our primary outcome was a composite of adverse cardiovascular events, while secondary outcomes included all-cause mortality, incidence of stroke, incidence of cardiac arrest, hospitalization urgency, incidence of recurrent MI, adverse gastrointestinal events and levels of high-sensitivity C - reactive protein (Hs-CRP). Risk ratios (RR) and mean differences (MD) were pooled under the random-effects model.
Eleven trials with 7161 patients were included in our analysis out of which 3546 (49.51 %) were allocated to colchicine and 3591 (50.14 %) received placebo. Colchicine demonstrated statistically significant reduction in the composite of adverse cardiovascular events (RR = 0.75, 95 % CI: 0.60-0.94, P = 0.01, I = 47 %), and hospitalization urgency (RR = 0.46, 95 % CI: 0.31-0.68, P = 0.0001, I = 0 %) but statistically significant increment in adverse gastrointestinal events (RR = 1.86, 95 % CI: 1.14-3.02, P = 0.01, I = 79 %). However, all-cause mortality (RR = 1.00, 95 % CI: 0.72-1.39, P = 0.98, I = 0 %), incidence of cardiac arrest (RR = 0.81, 95 % CI: 0.33-1.95, P = 0.63, I = 0), incidence of stroke (RR = 0.45, 95 % CI: 0.17-1.19, P = 0.11, I = 36 %), incidence of recurrent MI (RR = 0.78, 95 % CI: 0.57-1.06, P = 0.11, I = 11 %) and the levels of hs-CRP (MD= -0.87, 95 %CI: -1.80-0.06, P=0.07, I=67 % remained comparable across the two groups.
The use of colchicine post-MI reduces the composite of adverse cardiovascular events, and hospitalization urgency but increases adverse gastrointestinal events. However, colchicine does not impact all-cause mortality, cardiac arrest, stroke incidence, incidence of recurrent MI and the levels of hs-CRP. Large scale multicenter RCTs especially with longer follow-up duration are warranted to validate these findings.
心肌梗死（MI）与事件后炎症反应密切相关，进一步影响 MI 后的预后。秋水仙碱是一种抗炎药物，在各种心血管疾病中具有潜在益处，如冠状动脉疾病、心包炎和心房颤动。本荟萃分析主要旨在提供秋水仙碱在降低急性 MI 后患者不良心血管事件方面的疗效和安全性的最新评估。
我们对 PubMed、Cochrane 图书馆、Scopus、Google Scholar 和 clinicaltrials.gov 进行了全面检索，以查找从研究开始到 2024 年 5 月期间研究秋水仙碱对 MI 患者影响的随机对照试验（RCT）。我们的主要结局是不良心血管事件的综合结果，次要结局包括全因死亡率、卒中发生率、心脏骤停发生率、住院紧急程度、复发性 MI 发生率、不良胃肠道事件和高敏 C 反应蛋白（hs-CRP）水平。采用随机效应模型对风险比（RR）和平均差异（MD）进行汇总。
我们的分析纳入了 11 项试验，共 7161 例患者，其中 3546 例（49.51%）分配到秋水仙碱组，3591 例（50.14%）接受安慰剂治疗。秋水仙碱在复合不良心血管事件（RR=0.75，95%CI：0.60-0.94，P=0.01，I=47%）和住院紧急程度（RR=0.46，95%CI：0.31-0.68，P=0.0001，I=0%）方面显示出统计学显著降低，但在不良胃肠道事件（RR=1.86，95%CI：1.14-3.02，P=0.01，I=79%）方面显示出统计学显著增加。然而，全因死亡率（RR=1.00，95%CI：0.72-1.39，P=0.98，I=0%）、心脏骤停发生率（RR=0.81，95%CI：0.33-1.95，P=0.63，I=0%）、卒中发生率（RR=0.45，95%CI：0.17-1.19，P=0.11，I=36%）、复发性 MI 发生率（RR=0.78，95%CI：0.57-1.06，P=0.11，I=11%）和 hs-CRP 水平（MD=-0.87，95%CI：-1.80-0.06，P=0.07，I=67%）在两组之间没有差异。
MI 后使用秋水仙碱可降低不良心血管事件和住院紧急程度的复合结果，但会增加不良胃肠道事件。然而，秋水仙碱对全因死亡率、心脏骤停、卒中发生率、复发性 MI 发生率和 hs-CRP 水平没有影响。需要更大规模的多中心 RCT 特别是具有更长随访时间的 RCT 来验证这些发现。
