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Background <p>The European Society of Cardiology (ESC) recently endorsed low-dose colchicine for chronic coronary syndrome. However, its role in acute coronary syndrome (ACS) remains uncertain due to inconsistent trial outcomes. This systematic review and meta-analysis aimed to assess the efficacy and safety of colchicine in patients with ACS.</p> Methods <p>A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted through April 2025 to identify randomized controlled trials (RCTs) evaluating colchicine in adults with ACS. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular mortality, stroke, myocardial infarction (MI), major adverse cardiovascular events (MACE), coronary revascularization, and gastrointestinal (GI) adverse events. Data were pooled using a random-effects model to estimate relative risks (RRs) with 95% confidence intervals (CIs), using the longest available follow-up.</p> Results <p>Eleven RCTs encompassing 12,730 patients were included. Among them, 6,844 received colchicine for at least one month, while 5,886 received placebo or no additional treatment. Colchicine did not significantly reduce all-cause mortality (RR 0.95, 95% CI: 0.79–1.14) or cardiovascular mortality (RR 1.03, 95% CI: 0.82–1.29). No significant reductions were observed in MACE, MI, stroke, or coronary revascularization. Colchicine was associated with a non-significant trend toward increased GI adverse events, particularly at higher doses.</p> Conclusion <p>This meta-analysis does not support the routine use of colchicine in ACS management. While generally safe, colchicine did not confer clear cardiovascular benefits in this setting. However, potential subgroup effects, such as in longer-term use or among specific high-risk populations, warrant further investigation in future large-scale, well-designed trials.</p>

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Efficacy and safety of colchicine in patients with acute coronary syndrome: a systematic review and meta-analysis of randomized controlled trials

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月29日

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  • Parisa Fallahtafti,
  • Mashood Farooqi,
  • Mehdi Azizmohammad Looha,
  • Amirali Azizpour,
  • Yasaman Mohammadi,
  • Mehra Fekri,
  • Fatemeh Jodeiri,
  • Delnia Namdari Hemmati,
  • Fatemeh Mosayebi,
  • Pedram Pirmoradian,
  • Yaser Jenab,
  • Fady Iskander,
  • Dhaval Kolte,
  • Diaa Hakim,
  • Amr Mohsen,
  • Kaveh Hosseini

摘要

Background

The European Society of Cardiology (ESC) recently endorsed low-dose colchicine for chronic coronary syndrome. However, its role in acute coronary syndrome (ACS) remains uncertain due to inconsistent trial outcomes. This systematic review and meta-analysis aimed to assess the efficacy and safety of colchicine in patients with ACS.

Methods

A comprehensive search of PubMed, Embase, and the Cochrane Library was conducted through April 2025 to identify randomized controlled trials (RCTs) evaluating colchicine in adults with ACS. The primary outcome was all-cause mortality. Secondary outcomes included cardiovascular mortality, stroke, myocardial infarction (MI), major adverse cardiovascular events (MACE), coronary revascularization, and gastrointestinal (GI) adverse events. Data were pooled using a random-effects model to estimate relative risks (RRs) with 95% confidence intervals (CIs), using the longest available follow-up.

Results

Eleven RCTs encompassing 12,730 patients were included. Among them, 6,844 received colchicine for at least one month, while 5,886 received placebo or no additional treatment. Colchicine did not significantly reduce all-cause mortality (RR 0.95, 95% CI: 0.79–1.14) or cardiovascular mortality (RR 1.03, 95% CI: 0.82–1.29). No significant reductions were observed in MACE, MI, stroke, or coronary revascularization. Colchicine was associated with a non-significant trend toward increased GI adverse events, particularly at higher doses.

Conclusion

This meta-analysis does not support the routine use of colchicine in ACS management. While generally safe, colchicine did not confer clear cardiovascular benefits in this setting. However, potential subgroup effects, such as in longer-term use or among specific high-risk populations, warrant further investigation in future large-scale, well-designed trials.