Print Share Email Send Email Your Name (required) ! Example: John Doe Email Address (required) ! Error: Please enter a valid sender email address. Example: email@example.com CC Me Recipient Email Address (required) ! Separate multiple email address with semi-colons (up to 5). Subject Subject for your email. Message (Maximum characters: 1,000) Error: Please enter your name Error: Please enter your email address Error: Please enter a valid recipient email address. Example:firstname.lastname@example.org Thank you! Your email has been sent to: The recipient(s) will receive an email message that includes a link to the selected article. Recipients may need to check their spam filters or confirm that the address is safe. Return to: Send Another Email An error has occurred sending your email(s). Please try again later or contact an administrator at OnlineCustomer_Service@email.mheducation.com. Return to: Twitter Facebook Linkedin Reddit Get Citation Citation Disclaimer: These citations have been automatically generated based on the information we have and it may not be 100% accurate. Please consult the latest official manual style if you have any questions regarding the format accuracy. AMA Citation Lampert J, Naib T. Lampert J, & Naib T Lampert, Joshua, and Tara Naib. Low-Dose Colchicine Reduces the Incidence of Cardiovascular Events after Myocardial Infarction: The COLCOT Trial. Hurst's the Heart Updates, 19 December 2019. McGraw-Hill, 2019. AccessCardiology. https://accesscardiology.mhmedical.com/updatesContent.aspx?gbosid=514996§ionid=234854651APA Citation Lampert J, Naib T. Lampert J, & Naib T Lampert, Joshua, and Tara Naib. (2019). Low-dose colchicine reduces the incidence of cardiovascular events after myocardial infarction: the colcot trial. Fuster V. Fuster V Fuster, Valentin. Hurst's the heart updates. McGraw-Hill. https://accesscardiology.mhmedical.com/updatesContent.aspx?gbosid=514996§ionid=234854651.MLA Citation Lampert J, Naib T. Lampert J, & Naib T Lampert, Joshua, and Tara Naib. "Low-Dose Colchicine Reduces the Incidence of Cardiovascular Events after Myocardial Infarction: The COLCOT Trial." Hurst's the Heart Updates Fuster V. Fuster V Fuster, Valentin. McGraw-Hill, 2019, https://accesscardiology.mhmedical.com/updatesContent.aspx?gbosid=514996§ionid=234854651. Download citation file: RIS (Zotero) EndNote BibTex Medlars ProCite RefWorks Reference Manager Mendeley © Copyright Tools Clip Full Chapter Figures Only Tables Only Videos Only Supplementary Content Top Low-Dose Colchicine Reduces the Incidence of Cardiovascular Events after Myocardial Infarction: The COLCOT Trial by Joshua Lampert, Tara Naib Listen + +Update to Chapter 39: Evaluation and Management of Non-ST-Segment Elevation Myocardial Infarction and Chapter 40: ST-Segment-Elevation Myocardial Infarction Study Summary + +The COLCOT trial was a randomized, double-blind, placebo-controlled study in which the efficacy and safety of low-dose colchicine was investigated in 4,745 patients with recent myocardial infarction (MI). Patients underwent 1:1 randomization to colchicine (0.5 mg daily) or placebo; the median duration of follow-up was 22.6 months. The trial included patients who had an MI within 30 days of enrollment, had undergone planned percutaneous revascularization procedures (93% of patients), and were treated in accordance with guidelines. The primary efficacy endpoint was a composite of death from cardiovascular causes, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina leading to coronary revascularization. +The primary endpoint occurred in 5.5% of patients in the colchicine group compared with 7.1% in the placebo group (HR 0.77; 95% CI 0.61–0.96; P = 0.02). The significant reduction in the primary endpoint in the colchicine group was driven by a lower incidence of stroke and urgent hospitalization for angina leading to coronary revascularization. The study drug was well-tolerated and was associated with a similar incidence of infection and diarrhea compared with placebo. Commentary + +Study Strengths: The study was a well-conducted, randomized, double-blind placebo-controlled trial using a medication that is orally administered, inexpensive, widely available, well-tolerated, and has a low side-effect profile. The patients in this trial represented a real-world demographic group, highlighting the challenges in managing coronary disease, as demonstrated by the proportion of active smokers in the cohort (30%). Interestingly, patients were appropriately treated after the index MI, with >98% of patients prescribed aspirin, an additional antiplatelet agent, and a statin. +Study Limitations: The study was not adequately powered to allow analysis of the components of the composite primary and secondary endpoints, and a larger trial would enable individual assessment of these outcomes. The duration of follow-up was relatively short, precluding evaluation of the longer-term impact of treatment with colchicine. Additionally, only 20% of the study population were female. +Next Steps/Clinical Perspective: The COLCOT trial highlights the emerging role of anti-inflammatory pharmacotherapy after MI, and demonstrates the clinical equipoise to pursue additional trials that are larger, of longer duration, and that investigate the use of other anti-inflammatory agents. In addition, large placebo-controlled trials to investigate the long-term impact of colchicine on stable coronary artery disease would be of interest. +COLCOT builds on previous investigations into immunomodulation. The tolerance of colchicine was not associated with an increased risk of fatal infection and neutropenia compared to placebo, a finding that was demonstrated in the CANTOS trial investigating canakinumab, a monoclonal antibody targeting interleikin-1β. Similarly, the negative CIRT trial investigated the role of methotrexate in reducing levels of interleukin-1β, interleukin-6, or C-reactive protein. Put in context, COLCOT focuses attention on the value of targeting the inflammatory cascade, while seeking to strike the balance between efficacy and adverse effects from immunosuppression. Trial Reference + + + +Tardif, J.-C. et al. Efficacy and safety of low-dose colchicine after myocardial infarction. N. Engl. J. Med. doi: 10.1056/NEJMoa1912388 (2019).