Colchicine Linked to Reduced Cardiovascular Events in Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA): AHJP December 2025 Study Finds

A recent large real-world cohort showed a trend toward reduced cardiovascular outcomes in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) who were on colchicine.

A portion of this work was presented at the 2025 American College of Cardiology Annual Scientific Session. The findings are published in the American Heart Journal Plus: Cardiology Research and Practice in December 2025.

The Unmet Clinical Need in Myocardial infarction with nonobstructive coronary arteries (MINOCA)

Myocardial infarction with nonobstructive coronary arteries (MINOCA) accounts for 5%–15% of all acute myocardial infarctions and represents a heterogeneous clinical syndrome. Defined by MI occurring in patients with <50% coronary stenosis and no alternative cause for myocardial injury, MINOCA carries higher cardiovascular morbidity and mortality than the general population, yet lacks disease-specific pharmacotherapy. Current treatment is largely extrapolated from obstructive MI despite limited evidence. Growing data highlight inflammation as a key mechanistic driver—supported by elevated markers such as C-reactive protein and NOD-like Receptor Protein 3 (NLRP3) inflammasome activation—which are linked to worse outcomes.

Study Overview

This retrospective cohort study used the TriNetX network, accessing de-identified EHR data from ~134 million patients across 102 healthcare organizations, to evaluate whether inflammation reduction benefits MINOCA patients. Adults aged 18–80 years with AMI who underwent catheterization without revascularization were included, while those with alternative causes of troponin elevation (e.g., Takotsubo syndrome, myocarditis, severe sepsis) were excluded to reduce misclassification. Colchicine exposure was defined as a documented prescription started during or after the index hospitalization and continued for at least one year. Using extensive 1:1 propensity-score matching, the study balanced demographics, cardiovascular risk factors, comorbidities, and inflammatory biomarkers, yielding 1188 colchicine users matched to 1188 controls. The primary outcome was a five-year composite of recurrent AMI, all-cause mortality, cerebrovascular events, and all-cause hospitalizations.

Key Findings - Significant Reduction in Hard Cardiovascular Endpoints

The analysis demonstrated favorable results for patients receiving colchicine:

• Primary Composite Outcome: The combined endpoint of recurrent AMI, all-cause mortality, cerebrovascular events, and all-cause hospitalizations was significantly lower in the colchicine group compared to controls (49.0% vs 55.1%).

• Recurrent MI and Mortality: Among secondary outcomes, the risk of AMI recurrence was significantly lower, and all-cause mortality was dramatically reduced in the colchicine arm.

• Trends: Heart failure events (HR 0.861) and all-cause hospitalizations (HR 0.892) showed a clinical trend toward lower rates with colchicine, though these differences did not reach statistical significance.

• Cerebrovascular Events: There was no difference observed in cerebrovascular events between the two groups.

Clinical Implications and Opportunities for Future Research

The finding that colchicine is associated with reduced cardiovascular morbidity and mortality in MINOCA provides a crucial signal for clinicians managing this complex patient group. Colchicine, acting as an NLRP3 inflammasome inhibitor, dampens vascular inflammation, limits leukocyte–endothelial adhesion, and improves microvascular flow. The observed benefit strongly supports the hypothesis that anti-inflammatory effects are critical in MINOCA pathophysiology, which involves endothelial injury, coronary vasospasm, and microvascular obstruction. Since MINOCA patients often have elevated systemic inflammatory markers, colchicine’s actions offer a coherent biological mechanism for improving outcomes. While this real-world retrospective study cannot establish causality, the results strongly suggest that colchicine, an accessible medication, should be further investigated as a potential targeted therapeutic strategy. These findings are hypothesis-generating and warrant confirmation in prospective, mechanism-specific clinical trials to further substantiate colchicine’s potential role in the secondary prevention of MINOCA.

Reference: Oro P, Vignarajah A, El Dahdah J, Vigneswaramoorthy N, Awakeem Y, Shah GV. Colchicine and cardiovascular outcomes in MINOCA: A retrospective cohort study. Am Heart J Plus. 2025 Oct 15;60:100643. doi: 10.1016/j.ahjo.2025.100643. PMID: 41146862; PMCID: PMC12554186.

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