Anti-inflammatory treatment with colchicine in acute coronary syndrome:A meta-analysis of randomized controlled trial

Background Inflammation has been identified as a central role in the pathogenesis of acute coronary syndrome. Colchicine is an inexpensive,potent anti-inflammatory properties drug which is suitable for treatment of acute coronary syndrome(ACS). Methods We systemically searched Pubmed,Embase,and the Cochrane library from their inception to November 19,2019.The inclusion criterion was published randomized controlled trials(RCTs)comparing difference between colchicine administration group and control group in ACS patients.All calculation was carried out by review manager 5.2. Results Five eligible RCTs incorporating 5257 patients were included. All patients in colchicine group toke colchicine 0.5 or 1 mg every single day in addition to standard treatment of ACS. There was no difference in the C-reactive protein(CRP)level,neutrophils count,white blood cell count,rangeability of CRP level and neutrophil count between the colchicine and control group and their standardized mean difference(SMD)were-0.13(95% CI:-0.36 to 0.11,P=0.29),-0.14(95% CI:-0.35 to 0.07,P=0.20),-0.02(95% CI:-0.10 to 0.07,P=0.70),-0.15(95% CI:-0.56 to 0.27,P=0.49)and-0.50(95% CI:-1.1 to 0.10,P=0.10),respectively. Compared with control group,colchicine group had a significant decrease in the morbidity of stroke(OR:0.27,95% CI:0.10-0.69,P=0.006)and revascularization(OR:0.50,95% CI:0.31-0.81,P=0.005).The incidence of gastrointestinal symptoms(OR:3.15,95% CI:1.11-8.98,P=0.03)obviously increased in colchicine group compared with control group. There were no significant difference in all-cause death(OR:0.98,95% CI:0.65-1.49,P=0.93)and recurrent myocardial infarction(OR:0.55,95% CI:0.17-1.75,P=0.31)between colchicine and control group. Conclusions Despite previous suggested colchicine therapy in coronary heart disease patients,our study did not lead to significant reduction in biomarkers of inflammation,all-cause death and recurrent myocardial infarction of ACS patients. Furthermore,colchicine may increase the adverse events. Further RCTs affirming the benefit of colchicine for secondary prevention of ACS would be of interest.[S Chin J Cardiol 2020;21(2):128-137]