Colchicine may prevent periprocedural myocardial injury in PCI: Study
Australia: The administration of colchicine on a median of 18 h pre-PCI led to a reduction in PCI-related myocardial injury that was associated with lower levels of inflammation pre-PCI but no difference was seen one-day post-PCI in the colchicine vs placebo groups, according to a new study in Cardiovascular Revascularization Medicine.
High inflammation levels pre-and post-percutaneous coronary intervention (PCI) is related to worse outcomes. Recent trials have shown that in coronary artery disease, treating inflammation may be beneficial. Jamie Layland, Peninsula Heart Service, Peninsula Health, Australia, and colleagues aimed to determine if the administration of colchicine pre-PCI, would attenuate the inflammatory effect of PCI in the randomized pilot COPE-PCI sub-study.
For this purpose, PCI patients were randomized to receive colchicine (n=36) or placebo (n=39), 6 to 24-hours pre-procedure. Study blood samples were taken immediately pre-PCI, and 24-hours post-procedure. Testing of the samples was done for a broad array of inflammatory biomarkers including leucocyte counts, high-sensitive(hs)-CRP, and hs-troponin-. Periprocedural Myocardial Injury (PM-Injury) was defined as per the ESC Third Universal Definitions of Myocardial Infarction.
The findings of the study were as follows:
- Treatment groups were similar for baseline variables. The median time from drug administration to pre-PCI blood sampling was 18-hours.
- Overall inflammation was low across the patient population, pre- & post-PCI hsCRP was <1.4 mg/L.
- Colchicine patients had numerically lower levels of pre-PCI cytokines: IL-1β, IL-6, IL-10, IFNγ, TNFα, and WBC count.
- Post-PCI (38-hours post-drug) measures of inflammation were similar between treatment arms.
- Absolute troponin change (post-PCI – pre-PCI levels) was less in colchicine patients.
"The post-PCI inflammatory response is complex and is dependent upon many factors," the authors explained. "Yet in our small study population, two doses of colchicine given 6 to 24-hours before PCI, was tied to numerically lower pre-PCI inflammatory cytokine levels, and less periprocedural myocardial injury.
The authors conclude, "the reduction in PCI-related myocardial injury that resulted from colchicine given on median 18 h pre-PCI, was related to numerically lower levels of inflammation pre-PCI but no difference one-day post-PCI in the colchicine vs placebo groups."
Reference:
Cole J, Htun N, Lew R, Freilich M, Quinn S, Layland J. COlchicine to Prevent PeriprocEdural myocardial Injury in Percutaneous Coronary Intervention (COPE-PCI): A descriptive cytokine pilot sub-study. Cardiovasc Revasc Med. 2021 Sep 30:S1553-8389(21)00668-0. doi: 10.1016/j.carrev.2021.09.006. Epub ahead of print. PMID: 34686461.
