COLCHICINE IN ACUTE CORONARY SYNDROMES: A META-ANALYSIS OF 12.602 PATIENTS.

IF 2.6 4区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Luigi Cappannoli, Francesco Fracassi, Cristina Aurigemma, Enrico Romagnoli, Francesco Bianchini, Mattia Lunardi, Rocco Antonio Montone, Lazzaro Paraggio, Carlo Trani, Giovanna Liuzzo, Francesco Burzotta
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引用次数: 0

Abstract

Inflammation is a leading cause of ischaemic heart disease. Aim of the present study is to assess whether treatment with colchicine in patients with ACS is associated with improved cardiovascular outcomes. We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) of patients with acute or recent ACS and treated with colchicine versus placebo. PubMed, Scopus, and the Cochrane Central Register of Controlled Trials databases were searched. The primary endpoint was composite of cardiovascular death, recurrent myocardial infarction (MI), stroke or urgent/unplanned revascularization. Other endpoints were individual components of the primary endpoint, all-cause death, non-cardiovascular death, and diarrhea. PROSPERO ID CRD42025648254. Three RCTs were included, involving 12,602 patients. There was no significant difference in the primary composite endpoint between the colchicine and placebo groups (OR 0.82, 95% CI 0.63-1.07, P=0.15). Analysis of individual components of the primary endpoint also revealed no significant differences between the colchicine vs. placebo groups: cardiovascular deaths (P=0.89), recurrent MI (P=0.17), strokes (P=0.27), urgent/unplanned revascularizations (P=0.14), all-cause death (P=0.95), non-cardiovascular death (P=0.98), and diarrhea (P=0.08). At the leave-one-out analysis, the exclusion of the CLEAR trial resulted in a significant reduction in primary endpoint (P=0.005). At further sensitivity analyses, the exclusion of patients who did not receive an initial twice-daily dose regimen and the exclusion of patients enrolled after COVID-19 pandemic resulted in a significant reduction in MACE (P=0.01 and P=0.001, respectively), reflecting heterogeneity among studies. The present meta-analysis raises new questions over the indication, timing and dosing of colchicine in patients with recent MI.

秋水仙碱治疗急性冠状动脉综合征:12.602例患者的荟萃分析
炎症是导致缺血性心脏病的主要原因。本研究的目的是评估秋水仙碱治疗ACS患者是否与改善心血管预后相关。我们对使用秋水仙碱与安慰剂治疗的急性或近期ACS患者的随机临床试验(rct)进行了系统回顾和荟萃分析。检索PubMed、Scopus和Cochrane Central Register of Controlled Trials数据库。主要终点为心血管死亡、复发性心肌梗死(MI)、卒中或紧急/计划外血运重建术。其他终点是主要终点的单个组成部分、全因死亡、非心血管死亡和腹泻。普洛斯彼罗id crd42025648254。纳入3项随机对照试验,共12602例患者。秋水仙碱组和安慰剂组的主要综合终点无显著差异(OR 0.82, 95% CI 0.63-1.07, P=0.15)。对主要终点的各个组成部分的分析也显示秋水仙碱组与安慰剂组之间没有显著差异:心血管死亡(P=0.89)、复发性心肌梗死(P=0.17)、中风(P=0.27)、紧急/计划外血管重建(P=0.14)、全因死亡(P=0.95)、非心血管死亡(P=0.98)和腹泻(P=0.08)。在留一分析中,排除CLEAR试验导致主要终点显著降低(P=0.005)。在进一步的敏感性分析中,排除未接受初始每日两次给药方案的患者和排除在COVID-19大流行后入组的患者导致MACE显著降低(P分别=0.01和P=0.001),反映了研究之间的异质性。本荟萃分析对近期心肌梗死患者秋水仙碱的适应症、时间和剂量提出了新的问题。
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来源期刊
CiteScore
5.10
自引率
3.30%
发文量
367
审稿时长
1 months
期刊介绍: Journal of Cardiovascular Pharmacology is a peer reviewed, multidisciplinary journal that publishes original articles and pertinent review articles on basic and clinical aspects of cardiovascular pharmacology. The Journal encourages submission in all aspects of cardiovascular pharmacology/medicine including, but not limited to: stroke, kidney disease, lipid disorders, diabetes, systemic and pulmonary hypertension, cancer angiogenesis, neural and hormonal control of the circulation, sepsis, neurodegenerative diseases with a vascular component, cardiac and vascular remodeling, heart failure, angina, anticoagulants/antiplatelet agents, drugs/agents that affect vascular smooth muscle, and arrhythmias. Appropriate subjects include new drug development and evaluation, physiological and pharmacological bases of drug action, metabolism, drug interactions and side effects, application of drugs to gain novel insights into physiology or pathological conditions, clinical results with new and established agents, and novel methods. The focus is on pharmacology in its broadest applications, incorporating not only traditional approaches, but new approaches to the development of pharmacological agents and the prevention and treatment of cardiovascular diseases. Please note that JCVP does not publish work based on biological extracts of mixed and uncertain chemical composition or unknown concentration.
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