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Introduction <p>Myocardial infarction (MI) remains a leading cause of morbidity and mortality worldwide. Persistent inflammation after MI contributes to adverse remodeling and recurrent events. Low-dose colchicine, traditionally used for gout and pericarditis, has been investigated as an adjunct to standard therapy to improve post-MI and coronary artery disease outcomes. This systematic review aimed to synthesize evidence from recent clinical trials evaluating the efficacy and safety of low-dose colchicine in post-MI recovery as well as long-term cardiovascular risk reduction.</p> Methodology <p>This PROSPERO-registered review (CRD42024605829) followed PRISMA guidelines. PubMed/MEDLINE, Embase, Google Scholar, Cochrane Library, and Web of Science were searched to July 2025 for randomized controlled trials of low-dose colchicine in adults with MI or coronary artery disease (CAD). Eligible studies reported short-term (≤ 12 months) and/or long-term (&gt; 12 months) cardiovascular outcomes and safety. Data extraction prioritized primary efficacy endpoints and adverse events.</p> Results <p>Eight trials involving 11,057 participants met the inclusion criteria. COLCOT showed that colchicine after MI reduced the composite primary endpoint versus placebo (5.5% vs. 7.1%, HR 0.77, <i>P</i> = 0.02). In a prespecified COLCOT analysis, initiation within 3 days post-MI yielded the greatest benefit over placebo (4.3% vs. 8.3%). A study reported lower major adverse cardiovascular events (MACE) over 6 months after acute coronary syndrome (6.7% vs. 21.7%, HR 1.64, 95% CI 1.31–2.05, <i>P</i> = 0.001). A COVERT-MI extension found no difference in 1-year MACE but higher left ventricular thrombus incidence with colchicine. The LoDoCo2 trial in chronic coronary artery disease found significant long-term MACE reduction (6.8% vs. 9.6%, HR 0.69, 95% CI 0.57– 0.83, <i>P</i> &lt; 0.001). By contrast, LoDoCo-MI observed no significant CRP reduction in CRP 30 days after acute MI. Gastrointestinal intolerance was the most frequent adverse event. Serious adverse events were rare.</p> Conclusion <p>High-quality evidence from large RCTs indicates that early, prolonged low-dose colchicine can reduce recurrent cardiovascular events after MI and in CAD, with a generally acceptable safety profile. Benefits appear most pronounced when treatment is initiated within days of the index event in MI; however, results are not uniformly consistent across all populations and follow-up durations. Further research is needed to address long-term safety and optimal timing of initiation.</p>

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Low-Dose Colchicine in Post-Myocardial Infarction Recovery and Long-Term Cardiovascular Health: A Systematic Review

  • 期刊论文

  • 发表日期：

    2025年9月25日

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  • Ikponmwosa Jude Ogieuhi,
  • Chidera Stanley Anthony,
  • Victor Oluwatomiwa Ajekiigbe,
  • Ifeoluwa Sandra Bakare,
  • Kristen Callender,
  • Boluwaduro Abasiekem Adeyemi,
  • Ganiyat Adekemi Adeshina,
  • Olufemi Akinmeji,
  • Chimezirim Ezeano,
  • Esther Bajo Tetteh

摘要

Introduction

Myocardial infarction (MI) remains a leading cause of morbidity and mortality worldwide. Persistent inflammation after MI contributes to adverse remodeling and recurrent events. Low-dose colchicine, traditionally used for gout and pericarditis, has been investigated as an adjunct to standard therapy to improve post-MI and coronary artery disease outcomes. This systematic review aimed to synthesize evidence from recent clinical trials evaluating the efficacy and safety of low-dose colchicine in post-MI recovery as well as long-term cardiovascular risk reduction.

Methodology

This PROSPERO-registered review (CRD42024605829) followed PRISMA guidelines. PubMed/MEDLINE, Embase, Google Scholar, Cochrane Library, and Web of Science were searched to July 2025 for randomized controlled trials of low-dose colchicine in adults with MI or coronary artery disease (CAD). Eligible studies reported short-term (≤ 12 months) and/or long-term (> 12 months) cardiovascular outcomes and safety. Data extraction prioritized primary efficacy endpoints and adverse events.

Results

Eight trials involving 11,057 participants met the inclusion criteria. COLCOT showed that colchicine after MI reduced the composite primary endpoint versus placebo (5.5% vs. 7.1%, HR 0.77, P = 0.02). In a prespecified COLCOT analysis, initiation within 3 days post-MI yielded the greatest benefit over placebo (4.3% vs. 8.3%). A study reported lower major adverse cardiovascular events (MACE) over 6 months after acute coronary syndrome (6.7% vs. 21.7%, HR 1.64, 95% CI 1.31–2.05, P = 0.001). A COVERT-MI extension found no difference in 1-year MACE but higher left ventricular thrombus incidence with colchicine. The LoDoCo2 trial in chronic coronary artery disease found significant long-term MACE reduction (6.8% vs. 9.6%, HR 0.69, 95% CI 0.57– 0.83, P < 0.001). By contrast, LoDoCo-MI observed no significant CRP reduction in CRP 30 days after acute MI. Gastrointestinal intolerance was the most frequent adverse event. Serious adverse events were rare.

Conclusion

High-quality evidence from large RCTs indicates that early, prolonged low-dose colchicine can reduce recurrent cardiovascular events after MI and in CAD, with a generally acceptable safety profile. Benefits appear most pronounced when treatment is initiated within days of the index event in MI; however, results are not uniformly consistent across all populations and follow-up durations. Further research is needed to address long-term safety and optimal timing of initiation.