COVERT MI

Effect of Colchicine on Myocardial Injury in acute Myocardial Infarction
@mewton_nathan. Circulation. 2021 DOI: 10.1161/CIRCULATIONAHA.121.056177

Clinical Question
-  In patients who present with an acute STEMI  and are referred for percutaneous coronary intervention (PCI), does colchicine in comparison with placebo reduce myocardial injury?

N = 194, 10 tertiary referral centres in France

Authors’ Conclusions
-  In patients with a first episode of STEMI and occluded culprit coronary artery, high dose colchicine given orally at the time of reperfusion for a short period did not reduce myocardial damage induced by ischaemia reperfusion injury compared with placebo

The Bottom Line
-  In patients presenting to my department with a STEMI, my acute management will not currently involve colchicine
-  The exact pathophysiology of reperfusion injury and mechanism in which colchicine may potentially create a protective atmosphere for cardiac tissue against it, may be more complex than predicted. As a result there are differing outcomes here compared to the pilot study on more comorbid patients in Greece with smaller infarcts. Mewton et al have attempted to mitigate any confounders including infarct size here with a strong methodology, however this study has given us more questions on the topic rather than answers
-  Further studies including looking at exact indications, dosage and timings may change my opinion in the future
-  COPE PCI has recently completed a promising pilot study which could help answer some of these questions