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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 Publisher Pubmed



Fallahtafti P ; Farooqi M ; Azizmohammad Looha MA ; Azizpour A ; Mohammadi Y ; Fekri M ; Jodeiri F ; Hemmati DN ; Mosayebi F ; Pirmoradian P ; Jenab Y ; Iskander F ; Kolte D ; Hakim D Show All Authors
Authors
  1. Fallahtafti P
  2. Farooqi M
  3. Azizmohammad Looha MA
  4. Azizpour A
  5. Mohammadi Y
  6. Fekri M
  7. Jodeiri F
  8. Hemmati DN
  9. Mosayebi F
  10. Pirmoradian P
  11. Jenab Y
  12. Iskander F
  13. Kolte D
  14. Hakim D
  15. Mohsen A
  16. Hosseini K

Source: BMC Cardiovascular Disorders Published:2025


Abstract

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. © 2025 Elsevier B.V., All rights reserved.