Is There a Role for Colchicine in Acute Coronary Syndromes? A Literature Review

Shrivastava

Indian Journal of Clinical Cardiology

et al. 2023

Some individuals develop a rare form of coronary heart disease called coronary artery ectasia (CAE). It is characterized by a dilation of more than one-third of the length of a coronary artery and a diameter that is 1.5 times that of the adjacent normal coronary artery. In the absence of significant coronary constriction, angina pectoris, positive stress tests, and acute coronary syndromes may all be indications of CAE. A distal embolization, vasospasm, or vascular rupture may cause thrombus formation in an ectatic artery. Antiplatelets, such as aspirin, are the cornerstone of treatment for people with CAE. Anticoagulants are used to prevent thrombus formation based on the presence of concurrent obstructive coronary artery disease and the patient’s risk of bleeding. As atherosclerosis is the most common cause of CAE, all patients are advised to take statins for primary prevention. Due to their anti-inflammatory properties, angiotensin-converting enzyme inhibitors may be prescribed to individuals with hypertension. If hypertension and coronary vasospasm occur simultaneously, beta-blockers and calcium channel blockers may be beneficial. Because they may aggravate symptoms, nitrates are normally not suggested. Other CAE treatment methods include the prevention of thromboembolic complications and percutaneous or surgical revascularization. CAE prognosis is determined on the severity of the associated coronary artery.

Section: Other Medicationsmentioning

confidence: 99%

Coronary Artery Ectasia

Shrivastava

Indian Journal of Clinical Cardiology

et al. 2023

Cardiovascular Therapeutics

“…Inflammation plays a key role in atherosclerosis. This point gives way to the idea of using anti-inflammatory substances as a treatment for coronary heart diseases for instance acute coronary syndrome [ 22 , 23 ]. Most studies in the field focused only on CAD or evaluated both ACS and CAD together which due to distinct pathophysiology in some aspects (such as acuteness or chronicity) [ 24 ] cast doubt on the validity of results.…”

Section: Discussionmentioning

confidence: 99%

Effect of Treatment with Colchicine after Acute Coronary Syndrome on Major Cardiovascular Events: A Systematic Review and Meta-Analysis of Clinical Trials

Razavi

Ramezani

Kazemi

et al. 2022

Aim. Colchicine as an anti-inflammatory drug might be effective in the treatment of atherosclerosis, an inflammatory-based condition. The aim of this systematic review and meta-analysis was to evaluate the impact of colchicine on acute coronary syndrome (ACS). Methods. We searched SCOPUS, PubMed, and Web of Science up to September 27, 2020. All clinical trials which evaluated the effect of colchicine on ACS patients and reported high-sensitivity C-reactive protein (hs-CRP) serum level or gastrointestinal (GI) adverse events with at least 5-day follow-up or death, myocardial infarction (MI), and stroke with at least 30-day follow-up as outcomes were included. Results. Finally, seven publications were analyzed. The results of our study revealed that colchicine has a marginally significant effect on hs-CRP attenuation. Furthermore, colchicine manifested promising results by declining the risk of stroke by 70%. However, MI and primary composite endpoint did not differ between the colchicine and noncolchicine groups. Although colchicine did not significantly increase GI adverse events in the pooled analysis, the dose-dependent effect was detected. Low-dose consumption can avoid GI side effects of colchicine. Conclusion. Colchicine has shown some molecular and clinical promising results in ACS patients. The lack of effect of colchicine on MI and all-cause mortality can be partly attributed to the limitations of previous studies. Since colchicine is an inexpensive and easy-to-access drug that has shown to be safe in low-dose regimens in the clinical setting; it would be worthy that future large-scale well-designed clinical trials address this issue by resolving the limitations of previous investigations.

“…In ammation plays a key role in atherosclerosis. This point gives way to the idea of using anti-in ammatory substances as a treatment for coronary heart diseases for instance acute coronary syndrome [33,34]. Most studies in the eld focused only on CAD or evaluated both ACS and CAD together which due to distinct pathophysiology in some aspects (such as acuteness or chronicity) [35], cast doubt on the validity of results.…”

Section: Discussionmentioning

confidence: 99%

Effect of Treatment with Colchicine After Acute Coronary Syndrome on Major Cardiovascular Events: A Meta-Analysis of Clinical Trials

Razavi¹,

Ramezani²,

Kazemi³

et al. 2021

Preprint

Purpose Colchicine as an anti-inflammatory drug might be effective in the treatment of atherosclerosis, an inflammatory-based condition. The aim of this systematic review and meta-analysis was to evaluate the impact of colchicine on acute coronary syndrome (ACS). Methods We searched SCOPUS, PubMed, and Web of Science up to September 27, 2020. All clinical trials which evaluated the effect of colchicine on ACS patients and reported high-sensitivity C-reactive protein (hs-CRP) serum level or gastrointestinal (GI) adverse events with at least 5-day follow up or death, Myocardial infarction (MI), and stroke with at least 30-day follow up as outcomes were included. Results Finally, seven publications were analyzed. The results of our study revealed that colchicine has a marginally significant effect on hs-CRP attenuation. Furthermore, colchicine manifested promising results by declining the risk of stroke by 70%. However, MI and primary composite endpoint did not differ between the colchicine and non-colchicine group. Although colchicine did not significantly increase GI adverse events in the pooled analysis, the dose-dependent effect was detected. Low dose consumption can avoid GI side effects of colchicine. Conclusion Colchicine has shown some molecular and clinical promising results in ACS patients. The lack of effect of colchicine on MI and all-cause mortality can be partly attributed to the limitations of previous studies. Since colchicine is an inexpensive and easy-to-access drug that has shown to be safe in low-dose regimens in the clinical setting, it worth that future large-scale well-designed studies address this issue by resolving the limitations of previous research.