Anti-Inflammatory Treatment With Colchicine in Acute Myocardial Infarction: A Pilot Study.
BACKGROUND
Inflammatory processes have been identified as key mediators of the deleterious effects of ischemia/reperfusion in ST-segment-elevation myocardial infarction. Colchicine is a substance with potent anti-inflammatory properties, suitable for safe use in patients with cardiovascular disease. The purpose of this study was to test the hypothesis that a short course of colchicine treatment could lead to reduced infarct size.


RESULTS
Patients presenting with ST-segment-elevation myocardial infarction ≤12 hours from pain onset (treated with primary percutaneous coronary intervention) were randomly assigned to colchicine or placebo for 5 days. The primary outcome parameter was the area under the curve of creatine kinase-myocardial brain fraction concentration. A subset of patients underwent cardiac MRI with late gadolinium enhancement 6 to 9 days after the index ST-segment-elevation myocardial infarction. One hundred fifty-one patients were included (60 in the MRI substudy). The area under the creatine kinase-myocardial brain fraction curve was 3144 (interquartile range [IQR], 1754-6940) ng·h(-1)·mL(-1) in the colchicine group in comparison with 6184 (IQR, 4456-6980) ng·h(-1)·mL(-1) in controls (P<0.001). Indexed MRI-late gadolinium enhancement-defined infarct size was 18.3 (IQR, 7.6-29.9) mL/1.73 m(2) in the colchicine group versus 23.2 (18.5-33.4) mL/1.73 m(2) in controls (P=0.019). The relative infarct size (as a proportion to left ventricular myocardial volume) was 13.0 (IQR, 8.0-25.3) % and 19.8 (IQR, 13.7-29.8) %, respectively (P=0.034).


CONCLUSIONS
These results suggest a potential benefit of colchicine in ST-segment-elevation myocardial infarction, but further clinical trials are necessary to draw secure conclusions, especially considering the fact that the present study was not powered to assess clinical end points.


BACKGROUND
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01936285.
From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.).
Spyridon
S
Deftereos
From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.). ggiann@med.uoa.gr georgios.giannopolous@yale.edu.
Georgios
G
Giannopoulos
From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.).
Christos
C
Angelidis
From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.).
Nikolaos
N
Alexopoulos
From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.).
Gerasimos
G
Filippatos
From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.).
Nikolaos
N
Papoutsidakis
From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.).
George
G
Sianos
From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.).
John
J
Goudevenos
From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.).
Dimitrios
D
Alexopoulos
From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.).
Vlasios
V
Pyrgakis
From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.).
Michael W
MW
Cleman
From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.).
Antonis S
AS
Manolis
From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.).
Dimitrios
D
Tousoulis
From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.).
John
J
Lekakis
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D019540:Area Under Curve; D015415:Biomarkers; D002097:C-Reactive Protein; D003078:Colchicine / Q000627:therapeutic use*; D052279:Creatine Kinase, MB Form / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D009206:Myocardium / Q000473:pathology; D010865:Pilot Projects; D011446:Prospective Studies
D000894:Anti-Inflammatory Agents, Non-Steroidal; D015415:Biomarkers; D002097:C-Reactive Protein; D052279:Creatine Kinase, MB Form; D003078:Colchicine
MB form; area under curve; creatine kinase; gadolinium; magnetic resonance imaging; neutrophil; troponin T