. 2025 Apr 21;7(7):860-870.

doi: 10.1016/j.cjco.2025.04.008. eCollection 2025 Jul.

Smoking, Colchicine and Postoperative Outcomes in Thoracic Surgery: Post Hoc Analysis of the COP-AF Randomized Controlled Trial

Sandra Ofori^{1

2}, Michael K Wang^{1

2}, Ekaterine Popova^{3

4}, William F McIntyre^{1

2}, Matthew Chan⁵, Daniel I Sessler⁶, Veronesi Giulia^{7

8}, Mark Warwas², Kumar Balasubramanian¹, Vikas Tandon², Christain Finley⁹, Gonzalez Tallada Anna¹⁰, Juan Cata¹¹, Sadeesh Srinathan¹², Cara Reimer¹³, Sean McLean¹⁴, Juan Carlos Trujillo¹⁵, Edith Fleischmann¹⁶, Luca Voltolini¹⁷, Patricia Cruz¹⁸, Donna E Maziak^{19

20}, Laura Gutiérrez-Soriano²¹, Mohammed Amir²², Matthias Bossard^{23

24}, Chew Yin Wang²⁵, P J Devereaux^{1

2}, David Conen^{1

2}; COP-AF investigators

Affiliations

¹ Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
² Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
³ Institut de Recerca Sant Pau, Barcelona, Spain.
⁴ Centro Cochrane Iberoamericano, Barcelona, Spain.
⁵ The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China.
⁶ Outcomes Research Consortium, Houston, Texas, USA.
⁷ Department of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁸ School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
⁹ Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
¹⁰ Vall d'Hebron, Barcelona, Spain.
¹¹ University of Texas, Houston, Texas, USA.
¹² University of Manitoba, Winnipeg, Manitoba, Canada.
¹³ Kingston General Hospital, Kingston, Ontario, Canada.
¹⁴ Vancouver Acute Department of Anesthesia and Perioperative Medicine, Vancouver General Hospital, British Columbia, Canada.
¹⁵ Thoracic Surgery Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
¹⁶ Medical University of Vienna, Vienna, Austria.
¹⁷ University of Florence, Florence, Italy.
¹⁸ Department of Anesthesiology, Reanimation and Pain treatment. University General Hospital Gregorio Marañón, Madrid, Spain.
¹⁹ University of Ottawa, Surgical Oncology, Division of Thoracic Surgery, Ottawa, Ontario, Canada.
²⁰ Ottawa Hospital, General Division, Ottawa, Ontario, Canada.
²¹ Anesthesiology Department, Anesthesiology Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.
²² Shifa International Hospital, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
²³ Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland.
²⁴ Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
²⁵ Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.

PMID: 40698308
PMCID: PMC12277807
DOI: 10.1016/j.cjco.2025.04.008

Smoking, Colchicine and Postoperative Outcomes in Thoracic Surgery: Post Hoc Analysis of the COP-AF Randomized Controlled Trial

Sandra Ofori et al. CJC Open. 2025.

. 2025 Apr 21;7(7):860-870.

doi: 10.1016/j.cjco.2025.04.008. eCollection 2025 Jul.

Authors

Affiliations

¹ Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
² Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
³ Institut de Recerca Sant Pau, Barcelona, Spain.
⁴ Centro Cochrane Iberoamericano, Barcelona, Spain.
⁵ The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China.
⁶ Outcomes Research Consortium, Houston, Texas, USA.
⁷ Department of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy.
⁸ School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
⁹ Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
¹⁰ Vall d'Hebron, Barcelona, Spain.
¹¹ University of Texas, Houston, Texas, USA.
¹² University of Manitoba, Winnipeg, Manitoba, Canada.
¹³ Kingston General Hospital, Kingston, Ontario, Canada.
¹⁴ Vancouver Acute Department of Anesthesia and Perioperative Medicine, Vancouver General Hospital, British Columbia, Canada.
¹⁵ Thoracic Surgery Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
¹⁶ Medical University of Vienna, Vienna, Austria.
¹⁷ University of Florence, Florence, Italy.
¹⁸ Department of Anesthesiology, Reanimation and Pain treatment. University General Hospital Gregorio Marañón, Madrid, Spain.
¹⁹ University of Ottawa, Surgical Oncology, Division of Thoracic Surgery, Ottawa, Ontario, Canada.
²⁰ Ottawa Hospital, General Division, Ottawa, Ontario, Canada.
²¹ Anesthesiology Department, Anesthesiology Research Group, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.
²² Shifa International Hospital, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
²³ Cardiology Division, Heart Center, Luzerner Kantonsspital, Lucerne, Switzerland.
²⁴ Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
²⁵ Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.

PMID: 40698308
PMCID: PMC12277807
DOI: 10.1016/j.cjco.2025.04.008

Abstract
in English, French

Background: To determine, among patients who underwent major noncardiac thoracic surgery, the association between smoking and perioperative atrial fibrillation (AF) and myocardial injury after noncardiac surgery (MINS), and whether the effect of colchicine use on these outcomes varied by smoking status.

Methods: This study is a subgroup analysis of the Colchicine for the Prevention of Perioperative Atrial Fibrillation (COP-AF) randomized clinical trial. A total of 3209 participants who underwent major noncardiac thoracic surgery were randomized to receive colchicine, 0.5 mg twice daily, or identical placebo, for 10 days starting 2-4 hours before surgery. The co-primary outcomes were clinically significant perioperative AF and MINS during the 14-day follow-up.

Results: A total of 687 (21.4%) were current smokers, 1577 (49.1%) were former smokers, and 945 (29.5%) were never smokers. AF occurred in 7.7%, 7.6%, and 5.3%, and MINS occurred in 21.0%, 19.7%, and 17.6% of current, former, and never smokers, respectively. Compared to never smokers, the adjusted hazard ratio for AF was 1.72 (95% confidence interval [CI] 1.07-2.77, P = 0.02) in current smokers and 1.46 (95% CI 0.99-2.16, P = 0.06) in former smokers, and the adjusted hazard ratio for MINS was 1.16 (95% CI 0.87-1.54, P = 0.32) in current smokers and 1.02 (95% CI 0.81-1.28, P = 0.88) in former smokers. No interaction occurred between smoking status and colchicine allocation for AF (interaction P, 0.82) or MINS (interaction P, 0.08).

Conclusions: Current smoking was associated with a small but increased risk of perioperative AF but not MINS after thoracic surgery. The effect of colchicine use on either outcome was not modified by smoking status.

Clinical trial registration: NCT03310125.

Contexte: Déterminer le lien entre le tabagisme, la fibrillation auriculaire (FA) periopératoire et les lésions myocardiques après une chirurgie non cardiaque chez des patients ayant subi une chirurgie thoracique majeure non cardiaque, et établir si l’effet de la colchicine sur ces paramètres varie en fonction du statut tabagique.

Méthodologie: Il s’agit d’une analyse de sous-groupes de l’essai clinique COP-AF (Colchicine for the Prevention of Perioperative Atrial Fibrillation) dans le cadre de laquelle 3 209 participants ayant subi une chirurgie thoracique majeure non cardiaque ont été répartis aléatoirement pour recevoir de la colchicine à raison de 0,5 mg deux fois par jour ou un placebo identique pendant 10 jours, à compter de 2 à 4 heures avant l’intervention chirurgicale. Les paramètres d’évaluation principaux conjoints étaient une FA périopératoire et les lésions myocardiques cliniquement significatives pendant un suivi de 14 jours.

Résultats: Au total, 687 participants (21,4 %) étaient fumeurs; 1 577 (49,1 %) étaient des ex-fumeurs et 945 (29,5 %) n’avaient jamais fumé. Une FA a été observée chez 7,7 %, 7,6 % et 5,3 %, et des lésions myocardiques chez 21,0 %, 19,7 % et 17,6 % des fumeurs, des ex-fumeurs et des participants n’ayant jamais fumé, respectivement. Comparativement aux participants n’ayant jamais fumé, le rapport de risques ajusté (RRA) pour la FA a été de 1,72 (intervalle de confiance [IC] à 95 % : 1,07-2,77; p = 0,02) chez les fumeurs et de 1,46 (IC à 95 % : 0,99-2,16; p = 0,06) chez les ex-fumeurs, et le RRA pour les lésions myocardiques, de 1,16 chez les fumeurs (IC à 95 % : 0,87-1,54; p = 0,32) et de 1,02 chez les ex-fumeurs (IC à 95 % : 0,81-1,28; p = 0,88). Aucune interaction n’a été observée entre le statut tabagique et l’affectation au groupe traité par la colchicine pour une FA (valeur p de l’interaction = 0,82) ou une lésion myocardique (valeur p de l’interaction = 0,08).

Conclusion: Chez les fumeurs, le risque de FA périopératoire était légèrement plus élevé, ce qui n’était pas le cas pour les lésions myocardiques après une chirurgie thoracique. L’effet de la colchicine sur l’un ou l’autre de ces paramètres n’a pas été modifié par le statut tabagique.

Enregistrement de l’essai clinique: ClinicalTrials.gov, NCT03310125.

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Figures

**Figure 2**
Subgroup analysis of smoking status on (A) the 2 co-primary outcomes, and (B) the safety outcomes. CI, confidence interval.

See this image and copyright information in PMC

References

1. Moller A.M., Villebro N., Pedersen T., Tonnesen H. Effect of preoperative smoking intervention on postoperative complications: a randomised clinical trial. Lancet. 2002;359:114–117. - PubMed
1. Grønkjær M., Eliasen M., Skov-Ettrup L.S., et al. Preoperative smoking status and postoperative complications: a systematic review and meta-analysis. Ann Surg. 2014;259:52–71. - PubMed
1. Yamamichi T., Ichinose J., Iwamoto N., et al. Correlation between smoking status and short-term outcome of thoracoscopic surgery for lung cancer. Ann Thorac Surg. 2022;113:459–465. - PubMed
1. King M., Howell G., Hunter V. Hospital readmission rates within 30 days following thoracic oncology surgery. J Thorac Oncol. 2017;12(1 Suppl 1):S1108–S1109.
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Smoking, Colchicine and Postoperative Outcomes in Thoracic Surgery: Post Hoc Analysis of the COP-AF Randomized Controlled Trial

Affiliations

Smoking, Colchicine and Postoperative Outcomes in Thoracic Surgery: Post Hoc Analysis of the COP-AF Randomized Controlled Trial

Authors

Affiliations

Abstract
in English, French

Figures

References

Associated data

LinkOut - more resources

Full Text Sources

Medical

Abstract in English, French

Figures

References

Associated data

LinkOut - more resources

Full Text Sources

Medical

Abstract
in English, French