Physicians' Academy for Cardiovascular Education

Anti-inflammatory treatment within 3 days after MI improves CV outcomes

Time-to-treatment initiation of colchicine and cardiovascular outcomes after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT)

Literature - Bouabdallaoui N, Tardif JC, Waters DD, et al. - Eur Heart J. 2020;41:4092-4099. doi: 10.1093/eurheartj/ehaa659.

Introduction and methods

Myocardial infarction (MI) is associated with an acute excessive inflammatory burst. This inflammatory burst plays a role in adverse cardiac remodeling by activation of NLRP3 inflammasomes [1-4]. Colchicine is a potent anti-inflammatory medication, that inhibits tubulin polymerization leading to effects on cellular adhesion molecules, inflammatory chemokines, and the inflammasome [5-7]. In COLCOT, a daily low dose of colchicine reduced the risk of the CV primary endpoint by 23% when initiated in the first 30 days after an MI compared to placebo [8].

This subanalysis of COLCOT assessed whether time-to-treatment initiation (TTI) of colchicine therapy had a clinical impact on CV outcomes in patients with an MI.

COLCOT was an international, multicenter, randomized, double-blind trial. Patients with a recent MI (<30 days) were included and randomized (1:1) to colchicine 0.5 mg once daily (n=2322) or matching placebo (n=2339). Patients were subdivided into three TTI groups: day 0-3 (in-hospital management; n=1193), day 4-7 (early post-discharge period; n=720), and day 8-30 (late post-discharge period; n=2748). The primary efficacy endpoint was a composite of CV death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina requiring coronary revascularization. Secondary endpoints included the components of the primary outcome, all-cause death, and a composite of CV death, resuscitated cardiac arrest, MI, or stroke. Exploratory endpoints were all coronary revascularizations, which included elective and urgent coronary revascularizations. Median follow-up was 22.7 months.

Main results


Early initiation of low-dose colchicine between day 0 and 3 in patients who suffered from a MI reduced the risk of the primary composite endpoint by 48% compared to patients receiving placebo. Most prominent effect of early colchicine treatment initiation was observed for urgent hospitalization due to angina leading to coronary revascularization. Also, the secondary composite endpoint and all coronary revascularization events were significantly reduced in the early initiated colchicine treated group compared to placebo.


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Find this article online at Eur Heart J

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