Colchicine to prevent cardiovascular death after an acute myocardial infarction.

Abstract

Background: Clinical and experimental evidence have demonstrated the protective benefits of colchicine in acute myocardial infarction (AMI) through its potential anti-inflammatory effect. However, investigations on the Asian population are limited.

Methods: This retrospective longitudinal cohort study used electronic medical records from a tertiary medical center in Taiwan. Patients with their first AMI from the emergency department between 2010 and 2020 were included. The outcomes included all-cause death, hospitalization for heart failure, stroke, and emergency admission for angina. Propensity-score matching (PSM, 5 to 1) and Cox's proportional hazards regression model were used to estimate hazard ratios (HRs).

Results: A total of 2841 patients with their first admission for AMI were identified, of which 176 (6.2%) received colchicine and 2665 (93.8%) did not. After a median follow-up of 21.4 months, the incidence of all-cause death was significantly reduced in the colchicine group (HR, 0.560; 95% confidence interval [CI], 0.361-0.862; P = 0.008), driven by the significant risk reduction of cardiovascular death (HR, 0.291; 95% CI, 0.142-0.613; P = 0.001). There was no significant difference of other outcomes. After PSM, the protective effect remained in the colchicine group compared with non-users (HR, 0.331; 95% CI, 0.162-0.690; P = 0.003). The relationship between endpoints and various time-to-treatment initiation showed a significant reduction in the risk of all-cause death for whom colchicine was initiated < Day 3 compared with placebo.

Conclusions: Low-dose colchicine led to a significantly lower risk of cardiovascular death than non-users among patients with a recent myocardial infarction. They benefit from early, in-hospital initiation of colchicine after AMI.