Periprocedural Colchicine Does Not Decrease PCI-Related Injuries

Binita Shah, MD

Despite a study highlighting colchicine as a treatment for reducing cardiovascular events in some patients, another study at the American Heart Association (AHA) 2019 Scientific Sessions in Philadelphia has found colchicine provides no benefit when administered before percutaneous coronary intervention(PCI) procedures.

Results of the Effects of Acute Colchicine Administration Prior to Percutaneous Coronary Intervention (COLCHICINE-PCI) study revealed a preprocedural dose of 1.8 mg colchicine did not lower the risk of PCI-related myocardial injury or major adverse cardiovascular events.

To evaluate the potential impact of short-term preprocedural colchicine, investigators designed a single-site, randomized, double-blind, prospective study with the intention of comparing effects of colchicine versus placebo on markers of myocardial injury and inflammation. The primary outcome measure of the study was PCI-related myocardial injury. Secondary outcomes included composite of death from any cause, non-fatal myocardial infarction or target vessel revascularization at 30 days and PCI-related myocardial infarction.

In total, investigators screened a cohort of 1453 patients for inclusion in the study. Ultimately, after application of inclusion criteria and approached participants for enrollment, 206 patients in the colchicine group underwent PCI and 194 patients underwent the procedure in the placebo group.

Upon analyses, 118(57.3%) of patients experienced PCI-related myocardial injury compared to 122 (64.2%) of placebo patients (P=0.19). In regard to secondary outcomes, the percentage of 30-day major adverse cardiovascular 11.7% (n=24) in colchicine patients and 12.9% (n=25) for patients in the placebo arm (P=0.82).

An additional analyses was performed by investigators to determine the impact of preprocedural colchicine use on antiinflammatory biomarkers. The substudy revealed colchicine had did not impact percent change in IL-1b , but noted greater changes in IL-6 concentration and hsCRP concentration compared to baseline percentages.

Investigators noted multiple limitations of their study, including a disproportionate male population, observations were limited to specific endpoints and biomarkers, and genetic data was not collected to determine predispositions to colchicine resistance.

This study, titled “Effects of Acute Colchicine Administration Prior to Percutaneous Coronary Intervention: The COLCHICINE-PCI Randomized Trial,” was presented at AHA 2019 by Binita Shah, MD, MS.