Colchicine in Patients With Recent Myocardial Infarction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND

The role of colchicine, an anti-inflammatory agent, in improving cardiovascular outcomes in patients with recent myocardial infarction remains unclear. We sought to evaluate the efficacy and safety of colchicine compared with placebo in patients with recent myocardial infarction (within 1 month of symptom onset) at a follow-up of at least 1 year.

METHODS

We systematically searched MEDLINE, Embase, and the Cochrane Library until January 2025 for randomized controlled trials comparing colchicine to placebo in recent myocardial infarction. The primary outcome was major adverse cardiovascular events (MACE; as defined by the included studies) at maximum follow-up. Secondary outcomes included individual MACE components and safety (serious adverse events [AEs], any AEs, and gastrointestinal AEs). Count data were pooled using random-effects models with inverse variance weighting to estimate risk ratios (RRs) and 95% CIs.

RESULTS

A total of 5 randomized controlled trials were included with 6620 patients randomized to colchicine and 6625 to placebo. Most participants (79%) were male, with mean ages ranging from 59 to 61 years. Follow-up durations ranged from 1 to 3 years. At maximum follow-up, there was no statistically significant difference in MACE between colchicine and placebo (8.2% versus 9.3%; RR, 0.83 [95% CI, 0.66-1.04]). Analyses of individual MACE components were also inconclusive. Randomization to colchicine did not increase the overall incidence of AEs or serious AEs compared with placebo.

CONCLUSIONS

In patients with recent myocardial infarction, the available evidence assessing the effect of colchicine, in addition to standard therapy, on MACE remains inconclusive over a median follow-up duration of 1 year.