Association of colchicine with atrial fibrillation and safety outcomes in patients with acute coronary syndrome

Abstract Background Although inflammation has been implicated to play a key role in development of coronary artery disease and cardiac arrhythmias such as atrial fibrillation (AF), studies evaluating the efficacy and safety of using colchicine for its anti-inflammatory properties in patients with acute coronary syndrome have yielded conflicting results. Purpose In this study, we performed a systematic review and meta-analysis evaluating the use of colchicine in patients with ACS, evaluating its association with risk of future development of AF, acute cerebrovascular accident (CVA), and safety endpoints. Methods A literature search was performed using the databases Pubmed, Embase, andWeb of Science, identifying studies that evaluated the association of colchicine with clinical endpoints in patients with ACS. Clinical endpoints include subsequent development of AF, CVA, gastrointestinal (GI) symptoms and incidence of infection. Randomized controlled trials and retrospective cohort studies were the primary sources of literature. The search was not restricted to time or publication status. Results A total of 14 studies with 27,344 patients with ACS met inclusion criteria for the endpoints of interest. 12,430 patients received Colchicine and 14,914 did not receive Colchicine. Mean follow up duration was 16.9 months, mean age was 61 years old, 76.9% of those enrolled were male. In patients with ACS, the use of colchicine was associated with a non-significant trend toward lower risk of AF and CVA during follow-up period (OR 0.82, 95% CI 0.63-1.07; p=0.14; OR 0.71, 95% CI 0.44 – 1.15; p=0.16). The trend toward lower risk of CVA in patients treated with colchicine was primarily seen in studies with mixed cohorts of ACS patients and was not seen in studies exclusively evaluating patients who presented with ST elevation myocardial infarction. The use of colchicine was associated with increased risk of GI side effects but no statistical difference in risk of infections (OR 1.47, 95% CI 1.05-2.06; p=0.03; OR 0.97, 95% CI 0.82-1.15; p=0.74). Conclusions Our study demonstrates a trend toward lower risk of atrial fibrillation and CVA in patients with ACS treated with colchicine. Meanwhile, use of colchicine is associated with increased risk of GI side effects without any significant increased risk of infections. Additional high-quality studies are required to further elucidate the association colchicine use with risk of AF and CVA outcomes as well as to assess if there are differences in the effects of colchicine based on type of ACS.Figure 1 Figure 2