Dissertation committee:
Λεκκάκης Ιωάννης, Ομότιμος Καθηγητής, Ιατρική, ΕΚΠΑ,
Ηλιοδρομίτης Ευστράτιος, Καθηγητής, Ιατρική, ΕΚΠΑ, ,
Δευτεραίος Σπυρίδωνας, Καθηγητής, Ιατρική, ΕΚΠΑ,
Φιλιππάτος Γεράσιμος, Καθηγητής Ιατρική, ΕΚΠΑ,
Παρίσης Ιωάννης, Καθηγητής Ιατρική, ΕΚΠΑ,
Ραλλίδης Λουκιανός, Καθηγητής, Ιατρική, ΕΚΠΑ,
Σιάσος Γεράσιμος, Αναπληρωτής Καθηγητής, Ιατρική, ΕΚΠΑ,
Summary:
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.
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 m2 in the colchicine group versus 23.2 (18.5-33.4) mL/1.73 m2 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).
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.
Keywords:
Reperfusion injury, Acute coronary syndrome, Colchicine, Cardiac Magnetic Resonance, Biomarkers
