Colchicine in Post-STEMI Patients for Prevention of Major Adverse Cardiovascular Events: A Systematic Review and Meta-Analysis

Abstract

Introduction: Inflammation drives adverse remodeling after ST-elevation myocardial infarction (STEMI). Colchicine, a low-cost anti-inflammatory, has shown promise in stable coronary disease. This review evaluates colchicine started within 48 hours of STEMI for MACE prevention.
Methods: Systematic review of RCTs (≥200 patients) comparing colchicine (0.5 mg daily) vs placebo post-STEMI, initiated ≤48 hours. Primary composite MACE: cardiovascular death, recurrent MI, or urgent revascularization at 1 year. Searched: PubMed, ClinicalTrials.gov (2015–2024).
Results: Five RCTs (n=6,211) included. Colchicine reduced primary MACE (10.3% vs 14.2%, RR 0.73, 95% CI 0.63–0.84). Number needed to treat = 26. No significant reduction in all-cause mortality (RR 0.91, 0.74–1.12). Diarrhea occurred in 9.7% (colchicine) vs 3.1% (placebo), p<0.001. Drug discontinuation due to gastrointestinal symptoms was 5.8%.
Discussion: Benefit emerged early (within 30 days) and persisted, consistent with NLRP3 inflammasome inhibition. However, two large trials excluded patients with prior colchicine intolerance, potentially underestimating real-world discontinuation. Subgroup analysis suggested benefit limited to those without chronic kidney disease.
Conclusions: Peri-STEMI colchicine reduces 1-year MACE at the cost of increased diarrhea. Routine use may be considered in STEMI patients without gastrointestinal contraindications.