Journal
EUROPEAN HEART JOURNAL
Volume 41, Issue 42, Pages 4092-4099Publisher
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehaa659
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Funding
- Government of Quebec
- Canadian Institutes of Health Research
- Montreal Heart Institute Foundation
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Aims The COLchicine Cardiovascular Outcomes Trial (COLCOT) demonstrated the benefits of targeting inflammation after myocardial infarction (MI). We aimed to determine whether time-to-treatment initiation (TTI) influences the beneficial impact of colchicine. Methods and results In COLCOT, patients were randomly assigned to receive colchicine or placebo within 30 days post-MI. Time-toand results treatment initiation was defined as the length of time between the index MI and the initiation of study medication. The primary efficacy endpoint was a composite of cardiovascular death, resuscitated cardiac arrest, MI, stroke, or urgent hospitalization for angina requiring coronary revascularization. The relationship between endpoints and various TTI (<3, 4-7 and >8 days) was examined using muttivariable Cox regression models. Amongst the 4661 patients included in this analysis, there were 1193, 720, and 2748 patients, respectively, in the three TTI strata. After a median follow-up of 22.7 months, there was a significant reduction in the incidence of the primary endpoint for patients in whom colchicine was initiated < Day 3 compared with placebo [hazard ratios (HR)= 0.52, 95% confidence intervals (CI) 0.32-0.84], in contrast to patients in whom colchicine was initiated between Days 4 and 7 (HR= 036, 95% CI 0.53-1.75) or > Day 8 (HR= 0.82, 95% CI 0.61-1.11). The beneficial effects of early initiation of colchicine were also demonstrated for urgent hospitalization for angina requiring revascularization (HR = 0.35), all coronary revascularization (HR= 0.63), and the composite of cardiovascular death, resuscitated cardiac arrest, MI, or stroke (HR= 0.55, all P < 0.05). Conclusion Patients benefit from early, in -hospital initiation of colchicine after MI.
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