The Efficacy of Colchicine in the Treatment of Recurrent Pericarditis Related to Postcardiac Injury (Postpericardiotomy and Postinfarcted) Syndrome: A Multicenter Analysis

Abstract

Background: Pericarditis related to the postcardiac injury syndrome (PCIS) following myocardial infarction or cardiac surgery is a troublesome and often recurrent clinical entity resistant to therapeutic interventions. The usefulness of colchicine in the prevention of recurrent PCIS has not been evaluated. Objective: We performed a cumulative analysis of available multicenter data with the aim of evaluating the efficacy of colchicine in the treatment of recurrent PCIS. Methods and Results: The study was designed as a multicenter all-cases analysis. Researchers who had published studies and case reports on colchicine treatment in recurrent pericarditis related to PCIS during the last 15 years were approached and asked to contribute all available cases to the database. There were 28 patients, 18 male (64%) and 10 female (36%), ranging in age from 21 to 82 years (mean 53 ± 15 years). PCIS pericarditis was secondary to pericardiotomy in 19 patients and infarction in 9. In 21 patients (75%), colchicine therapy was discontinued during follow-up and renewed only in the case of relapse. In these patients, the total period of treatment was summed up for analysis. 7 patients (25%) were taking colchicine as a permanent treatment, and no colchicine-free follow-up was documented. In total, 130 recurrences (mean 4.64 ± 3.7 per patient, range 2–16) were noted before colchicine therapy was initiated. During colchicine treatment (mean duration of treatment 16.6 ± 13.5 months), a significant reduction in the number of recurrences was observed. Only 5 of 28 patients (18%) presented with new recurrences (mean 0.25 ± 0.59 vs. 4.64 ± 3.7 per patient in the precolchicine period, p < 0.001). The mean follow-up period after colchicine discontinuation (data were available for 21 patients) was 31.9 ± 28 months; during follow-up, 13 patients (62%) remained recurrence free and 8 of them (38%) experienced relapses (mean 0.43 ± 0.6 per patient, p < 0.001 vs. precolchicine). Conclusions: It seems that colchicine may be effective in preventing new relapses in patients with recurrent pericarditis related to postcardiac injury both during active therapy and after its discontinuation.