title: Usefulness of colchicine to reduce perioperative myocardial damage in patients who underwent on-pump coronary artery bypass grafting.
abstract: The objective of the present study was to test whether a perioperative course of colchicine, in patients who underwent standard coronary artery bypass grafting, would result in reduced postoperative increase of myocardial injury biomarker levels. Patients were prospectively randomized to colchicine or placebo starting 48 hours before scheduled coronary artery bypass grafting and for 8 days thereafter (0.5 mg twice daily). The primary outcome parameter was maximal high-sensitivity troponin T (hsTnT) concentration within 48 hours after surgery. Secondary outcome measures were maximal creatine kinase-myocardial brain fraction (CK-MB) levels and area under the curve (AUC) of hsTnT and CK-MB concentrations; 59 patients were included. Maximal hsTnT was 616 pg/ml (396 to 986) in the colchicine group versus 1,613 pg/ml (732 to 2,587) in controls (p = 0.002). Maximal CK-MB was 44.6 ng/ml (36.6 to 68.8) and 93.0 ng/ml (48.0 to 182.3), respectively (p = 0.002). The median AUC for hsTnT was 40,755 pg h/ml (20,868 to 79,176) in controls versus 20,363 pg h/ml (13,891 to 31,661) in the colchicine group (p = 0.002). AUCs for CK-MB were 2,552 ng h/ml (1,564 to 4,791) in controls and 1,586 ng h/ml (1,159 to 2,073) in the colchicine group (p = 0.003). The main complaints associated with colchicine were, as expected, gastrointestinal, with 5 patients (16.7%) in the colchicine group reporting diarrhea versus 1 control (3.4%) (p = 0.195). In conclusion, a short perioperative course of colchicine was effective in attenuating postoperative increases of hsTnT and CK-MB compared with placebo. This finding, which needs confirmation in a larger clinical trial powered to assess clinical endpoints, suggests a potential role for this agent in reducing cardiac surgery-related myocardial damage.
authors.affiliation: Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut. Electronic address: ggiann@med.uoa.gr.
authors.forename: Georgios
authors.initials: G
authors.lastname: Giannopoulos
authors.affiliation: Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Angelidis
authors.affiliation: Department of Cardiac Surgery, Evangelismos General Hospital, Athens, Greece.
authors.forename: Vasileios K
authors.initials: VK
authors.lastname: Kouritas
authors.affiliation: Department of Cardiac Surgery, Evangelismos General Hospital, Athens, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Dedeilias
authors.affiliation: Second Department of Cardiology, University of Athens Medical School, Attikon Hospital, Athens, Greece.
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Filippatos
authors.affiliation: Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Cleman
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Panagopoulou
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Gerasimos
authors.initials: G
authors.lastname: Siasos
authors.affiliation: First Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tousoulis
authors.affiliation: Second Department of Cardiology, University of Athens Medical School, Attikon Hospital, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Lekakis
authors.affiliation: Department of Cardiology, Athens General Hospital "G. Gennimatas," Athens, Greece; Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Deftereos
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000601:surgery*; D000368:Aged; D003078:Colchicine / Q000008:administration & dosage*; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D052279:Creatine Kinase, MB Form / Q000097:blood*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006115:Greece / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood*; D050257:Tubulin Modulators / Q000008:administration & dosage
chemical_list: D020107:Troponin T; D050257:Tubulin Modulators; D052279:Creatine Kinase, MB Form; D003078:Colchicine