Optical coherence tomography assessment of the impact of colchicine on non-culprit coronary plaque composition after myocardial infarction.

IF 10.2 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Research Pub Date : 2025-04-29 DOI:10.1093/cvr/cvae191

Peter J Psaltis, Mau T Nguyen, Kuljit Singh, Ajay Sinhal, Dennis T L Wong, Richard Alcock, Sharmalar Rajendran, Rustem Dautov, Peter Barlis, Sanjay Patel, Thalia Salagaras, Jessica A Marathe, Christina A Bursill, Nicholas J Montarello, Stefan M Nidorf, Peter L Thompson, Julie Butters, Alana R Cuthbert, Lisa N Yelland, Juanita L Ottaway, Yu Kataoka, Giuseppe Di Giovanni, Stephen J Nicholls

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引用次数: 0

Abstract

Aims: Low-dose colchicine reduces the risk of cardiovascular events after myocardial infarction (MI). The purpose of this study was to assess the effect of colchicine post-MI on coronary plaque morphology in non-culprit segments by optical coherence tomography (OCT).

Methods and results: COCOMO-ACS was a double-blind, placebo-controlled trial that randomized 64 patients (median age 61.5 years; 9.4% female) with acute non-ST-segment elevation MI to colchicine 0.5 mg daily or placebo for a median of 17.8 months in addition to guideline-recommended therapy. Participants underwent serial OCT imaging within a matched segment of non-culprit coronary artery that contained at least one lipid-rich plaque causing ≥20% stenosis. The primary outcome was the change in minimum fibrous cap thickness (FCT) in non-culprit segments from baseline to final visit. Of those randomized, 57 (29 placebo, 28 colchicine) had evaluable imaging at baseline and follow-up. Overall, colchicine had no effect on relative (placebo +48.0 ± 35.1% vs. colchicine +62.4 ± 38.1%, P = 0.18) or absolute changes in minimum FCT (+29.2 ± 20.9 µm vs. + 37.2 ± 21.3 µm, P = 0.18), or change in maximum lipid arc (-38.8 ± 32.2° vs. -54.8 ± 46.9°, P = 0.18) throughout the imaged non-culprit segment. However, in patients assigned colchicine, cap rupture was less frequent (placebo 27.6% vs. colchicine 3.6%, P = 0.03). In post hoc analysis of 43 participants who had been followed for at least 16 months, minimum FCT increased to a greater extent in the colchicine group (placebo +38.7 ± 25.4% vs. colchicine +64.7 ± 34.1%, P = 0.005).

Conclusion: In this study, OCT failed to detect an effect of colchicine on the minimum FCT or maximum lipid arc of plaques in non-culprit segments post-MI. The post hoc observation that minimum FCT increased to a greater extent with colchicine after more prolonged treatment suggests that longer-term studies may be required to detect the effect of anti-inflammatory therapies on plaque morphology by OCT.

Clinical trial number: Australian New Zealand Clinical Trials Registry Identifier, ACTRN12618000809235, registered on the 11 May 2018.

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光学相干断层扫描评估秋水仙碱对心肌梗死后非冠状动脉斑块组成的影响。

背景：小剂量秋水仙碱可降低心肌梗死（MI）后发生心血管事件的风险。本研究旨在通过光学相干断层扫描（OCT）评估心肌梗死后服用秋水仙碱对非冠状动脉斑块形态的影响：COCOMO-ACS是一项双盲、安慰剂对照试验，该试验将64名急性非ST段抬高型心肌梗死患者（中位年龄61.5岁；9.4%为女性）随机分组，除接受指南推荐的治疗外，每天服用0.5毫克秋水仙碱或安慰剂，中位时间为17.8个月。受试者在非冠状动脉的匹配区段内接受连续 OCT 成像，该区段至少含有一个富脂斑块，导致狭窄≥20%。主要结果是非冠状动脉段最小纤维帽厚度（FCT）从基线到最终检查的变化。在随机受试者中，有 57 人（29 人使用安慰剂，28 人使用秋水仙碱）在基线和随访时进行了可评估的成像。总体而言，秋水仙碱对最小 FCT 的相对变化（安慰剂 +48.0±35.1% vs. 秋水仙碱 +62.4±38.1%，P=0.18）或绝对变化（+29.2±20.9 µm vs. +37.2±21.3 µm，P=0.18），以及整个成像非髓质段最大脂质弧度的变化（-38.8±32.2° vs. -54.8±46.9°，P=0.18）均无影响。然而，在使用秋水仙碱的患者中，冠盖破裂的发生率较低（安慰剂 27.6% vs. 秋水仙碱 3.6%，P=0.03）。在对随访至少 16 个月的 43 名参与者进行的事后分析中，秋水仙碱组的最小 FCT 增加幅度更大（安慰剂 +38.7±25.4% vs. 秋水仙碱 +64.7±34.1%，P=0.005）：在这项研究中，OCT 未能检测到秋水仙碱对心肌梗死后非病灶区段斑块的最小 FCT 或最大脂质弧的影响。事后观察发现，在更长时间的治疗后，秋水仙碱会在更大程度上增加最小FCT，这表明可能需要进行更长期的研究，才能通过OCT检测抗炎疗法对斑块形态的影响：澳大利亚-新西兰临床试验注册标识符ACTRN12618000809235，注册日期为2018年5月11日。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cardiovascular Research 医学-心血管系统

CiteScore

21.50

自引率

3.70%

发文量

547

审稿时长

1 months

期刊介绍： Cardiovascular Research Journal Overview: International journal of the European Society of Cardiology Focuses on basic and translational research in cardiology and cardiovascular biology Aims to enhance insight into cardiovascular disease mechanisms and innovation prospects Submission Criteria: Welcomes papers covering molecular, sub-cellular, cellular, organ, and organism levels Accepts clinical proof-of-concept and translational studies Manuscripts expected to provide significant contribution to cardiovascular biology and diseases