Colchicine does not reduce risk of atrial fibrillation or myocardial injury after non-cardiac surgery

1. Colchicine did not significantly reduce the risk of atrial fibrillation or myocardial injury after non-cardiac surgery.

2. Use of colchicine was associated with a higher incidence of non-infectious diarrhea.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Colchicine is an anti-inflammatory drug that may be used for the management of gout and pericarditis. Patients with perioperative atrial fibrillation and myocardial injury after non-cardiac surgery (MINS) occasionally have high inflammatory biomarkers and thus, they may benefit from colchicine therapy. This randomized controlled trial aimed to evaluate the effect of low-dose colchicine on the risk of atrial fibrillation and MINS. The primary outcome was the occurrence of clinically significant atrial fibrillation, while key secondary outcome was the incidence of myocardial injury after non-cardiac surgery. According to study results, colchicine did not significantly reduce the risk of clinically significant atrial fibrillation or MINS. In fact, colchicine was linked with an increased risk of non-infectious diarrhea. Although this study was well done, it was limited by the occurrence of non-infectious diarrhea as a notable side effect of colchicine, which may impact its clinical utility.

Click to read the study in The Lancet

Relevant Reading: Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction

In-depth [randomized-controlled trial]: Between Feb 14, 2018, and Jun 27, 2023, 15 368 patients were screened for eligibility across 45 sites in 11 countries. Included were patients ≥ 55 years old undergoing major non-cardiac thoracic surgery. Patients with known atrial fibrillation, on an anti-arrhythmic medication, or those with contraindications to colchicine were excluded from the study. Altogether, 3209 patients (1608 in colchicine and 1601 in placebo) were included in the final analysis. The primary outcome of atrial fibrillation was comparable in both groups (6.4% in colchicine vs. 7.5% in placebo, hazard ratio [HR] 0.85, 95% confidence interval [CI] 0.65-1.10, p=0.22). This was also the case for the secondary outcome of myocardial injury after non-cardiac surgery (18.3% in colchicine vs. 20.3% in placebo, HR 0.89, 95% CI 0.76-1.05, p=0.16). However, the use of colchicine was associated with a higher incidence of non-infectious diarrhea (8.3% in colchicine vs. 2.4% in placebo, HR 3.64 [2.54-5.22]). Overall, findings from this study suggest that colchicine administration did not effectively reduce the risk of atrial fibrillation or MINS and was associated with an increased risk of non-infectious diarrhea.

Image: PD

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