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Deftereos S, Giannopoulos G, Angelidis C, Alexopoulos N, Filippatos G, Papoutsidakis N, Sianos G, Goudevenos J, Alexopoulos D, Pyrgakis V, Cleman MW, Manolis AS, Tousoulis D, Lekakis J. Anti-Inflammatory Treatment With Colchicine in Acute Myocardial Infarction: A Pilot Study. Circulation 2015; 132:1395-403. [PMID: 26265659 DOI: 10.1161/circulationaha.115.017611] [Citation(s) in RCA: 184] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/05/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Inflammatory processes have been identified as key mediators of the deleterious effects of ischemia/reperfusion in ST-segment-elevation myocardial infarction. Colchicine is a substance with potent anti-inflammatory properties, suitable for safe use in patients with cardiovascular disease. The purpose of this study was to test the hypothesis that a short course of colchicine treatment could lead to reduced infarct size. METHODS AND RESULTS Patients presenting with ST-segment-elevation myocardial infarction ≤12 hours from pain onset (treated with primary percutaneous coronary intervention) were randomly assigned to colchicine or placebo for 5 days. The primary outcome parameter was the area under the curve of creatine kinase-myocardial brain fraction concentration. A subset of patients underwent cardiac MRI with late gadolinium enhancement 6 to 9 days after the index ST-segment-elevation myocardial infarction. One hundred fifty-one patients were included (60 in the MRI substudy). The area under the creatine kinase-myocardial brain fraction curve was 3144 (interquartile range [IQR], 1754-6940) ng·h(-1)·mL(-1) in the colchicine group in comparison with 6184 (IQR, 4456-6980) ng·h(-1)·mL(-1) in controls (P<0.001). Indexed MRI-late gadolinium enhancement-defined infarct size was 18.3 (IQR, 7.6-29.9) mL/1.73 m(2) in the colchicine group versus 23.2 (18.5-33.4) mL/1.73 m(2) in controls (P=0.019). The relative infarct size (as a proportion to left ventricular myocardial volume) was 13.0 (IQR, 8.0-25.3) % and 19.8 (IQR, 13.7-29.8) %, respectively (P=0.034). CONCLUSIONS These results suggest a potential benefit of colchicine in ST-segment-elevation myocardial infarction, but further clinical trials are necessary to draw secure conclusions, especially considering the fact that the present study was not powered to assess clinical end points. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01936285.
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Affiliation(s)
- Spyridon Deftereos
- From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.)
| | - Georgios Giannopoulos
- From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.).
| | - Christos Angelidis
- From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.)
| | - Nikolaos Alexopoulos
- From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.)
| | - Gerasimos Filippatos
- From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.)
| | - Nikolaos Papoutsidakis
- From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.)
| | - George Sianos
- From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.)
| | - John Goudevenos
- From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.)
| | - Dimitrios Alexopoulos
- From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.)
| | - Vlasios Pyrgakis
- From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.)
| | - Michael W Cleman
- From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.)
| | - Antonis S Manolis
- From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.)
| | - Dimitrios Tousoulis
- From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.)
| | - John Lekakis
- From Department of Cardiology, Athens General Hospital "G. Gennimatas", Greece (S.D., G.G., C.A., N.P., V.P.); 2nd Department of Cardiology, University of Athens Medical School, Attikon University Hospital, Greece (S.D., G.G., G.F., J.L.); Cardiology Department, Athens Euroclinic, Greece (N.A.); AHEPA University Hospital, Thessaloniki, Greece (G.S.); 1st Department of Cardiology, University of Ioannina Medical School, Greece (J.G.); Cardiology Department, University of Patras, Greece (D.A.); Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.W.C.); and 1st Department of Cardiology, University of Athens Medical School, Hippokration Hospital, Greece (A.S.M., D.T.)
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