The New England Journal of MedicineColchicine in Acute Myocardial Infarction

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This large-scale multicenter trial evaluated colchicine’s efficacy in preventing adverse cardiovascular events following myocardial infarction (MI). The study involved more than 7,000 patients across 14 countries and provides important evidence regarding the role of anti-inflammatory therapy in post-MI care.

Study Design:

• Multicenter, 2×2 factorial design randomized controlled trial conducted across 104 centers in 14 countries
• 7,062 patients with myocardial infarction randomized to receive colchicine or placebo
• Primary outcome: composite of cardiovascular death, recurrent MI, stroke, or unplanned ischemia-driven coronary revascularization
• Median follow-up period of 3 years
• C-reactive protein measured at 3 months in a subset of patients

Key Findings:

• Primary outcome occurred in 9.1% of colchicine group vs 9.3% of placebo group (HR 0.99; 95% CI 0.85-1.16; P=0.93)
• Individual components of primary outcome showed similar incidence between groups
• Colchicine reduced C-reactive protein levels by 1.28 mg/L compared to placebo at 3 months
• Higher incidence of diarrhea in colchicine group (10.2% vs 6.6%, P<0.001)
• No difference in serious infection rates between groups

HCN Medical Memo
Although colchicine effectively reduces inflammatory markers post-MI, this study suggests that targeting inflammation alone may not be sufficient to improve cardiovascular outcomes. The results indicate that routine colchicine administration following MI is not supported by current evidence, particularly given the increased risk of adverse effects such as diarrhea.

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