Colchicine confers no benefit for infarct size in ST-segment–elevation myocardial infarction

Among patients with ST-segment–elevation myocardial infarction, treatment with high-dose colchicine at the time of reperfusion does not minimize myocardial damage induced by ischemia-reperfusion and the resulting inflammation, a study has shown.

The study randomized 192 patients admitted for a first episode of ST-segment–elevation myocardial infarction referred for primary percutaneous coronary intervention to receive oral colchicine (2-mg loading dose followed by 0.5 mg twice a day; n=101) or matching placebo (n=91) for 5 days following admission.

The primary outcome of gadolinium enhancement–defined infarct size at day 5 was similar in the colchicine and placebo groups, with a mean LV mass of 26 g (interquartile range [IQR], 16–44) and 28.4 g (IQR, 14–40), respectively (p=0.87).

Likewise, there was no between-group differences seen in the secondary outcomes. At the 3-month follow-up, changes in LV end-diastolic volume were 2.4 percent in the colchicine group and –1.1 percent in the placebo group (p=0.49). The respective infarct sizes were 17 g and 18 g of LV mass (p=0.92).

Furthermore, significantly more patients in the colchicine than in the placebo group developed gastrointestinal adverse events during the treatment period (34 percent vs 11 percent, respectively; p=0.0002).

More studies that explore the timing, pharmacokinetics, and dose response of colchicine and other anti-inflammatory drugs are warranted to identify an effective therapy to reduce infarct size or limit remodeling.