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Am Fam Physician. 2020;102(4):248

Clinical Question

Does treatment with colchicine after myocardial infarction (MI) prevent recurrent cardiovascular events?

Bottom Line

Daily colchicine after MI reduces cardiovascular events, specifically strokes and hospitalizations for angina. It is inexpensive and well-tolerated and should be considered for patients with recent MIs who are already using guideline-directed therapy. (Level of Evidence = 1b)

Synopsis

Post-MI inflammation may play a role in atherosclerosis and lead to an increased risk of recurrent cardiovascular events. In this trial, investigators evaluated the role of colchicine, an inexpensive anti-inflammatory medication, in lowering the risk of ischemic cardiovascular events in patients with recent MIs. Adults who had an MI within the past 30 days and had completed any planned revascularization procedures were randomized, using concealed allocation, to receive colchicine 0.5 mg daily (n = 2,366) or placebo (n = 2,379). Those with severe heart failure, severe hepatic or renal disease, recent stroke, or recent coronary bypass surgery were excluded. The primary end point was a composite of death from cardiovascular causes, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina leading to coronary revascularization. The two groups were similar at baseline. The mean age was 61 years, 19% were women, 30% were smokers, 20% had diabetes mellitus, and almost all were treated with dual antiplatelet therapy and a statin. Median follow-up was 23 months, and patients received the trial drug for a median of 19 months. Overall, 5.5% of patients in the colchicine group had a primary end point event compared with 7.1% in the placebo group (hazard ratio [HR] = 0.77; 95% CI, 0.61 to 0.96; P = .02; number needed to treat [NNT] = 63). This result was primarily driven by a decrease in stroke (HR = 0.26; 95% CI, 0.10 to 0.70; NNT = 167) and a decrease in urgent hospitalizations for angina leading to revascularization (HR = 0.50; 95% CI, 0.31 to 0.81; NNT = 100). As far as adverse events, the colchicine group reported more nausea and flatulence than the control group. The colchicine group had a slightly higher rate of pneumonia, although the incidence was low (0.9% vs. 0.4%; P = .03).

Study design: Randomized controlled trial (double-blinded)

Funding source: Government

Allocation: Concealed

Setting: Inpatient (any location) with outpatient follow-up

Reference:TardifJCKouzSWatersDDet alEfficacy and safety of low-dose colchicine after myocardial infarction. N Engl J Med2019;381(26):2497–2505.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

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This series is coordinated by Sumi Sexton, MD, editor-in-chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

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