Efficacy and Safety of Colchicine in Reducing Reperfusion Injury Among Patients With ST-Segment Elevation Myocardial Infarction (STEMI): A Systematic Review and Clinical Appraisal

Abstract

This systematic review evaluated the efficacy and safety of colchicine in reducing ischemia-reperfusion injury among patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. A comprehensive literature search across five databases identified 92 records, with five studies meeting the inclusion criteria, encompassing 390 patients. The included studies comprised randomized controlled trials and prospective studies investigating various colchicine dosing regimens, from short-term high-dose protocols to prolonged maintenance therapy. Primary outcomes included infarct size, inflammatory biomarkers, major adverse cardiovascular events, and safety profiles. Results demonstrated heterogeneous findings across studies. While one trial showed trends toward reduced inflammatory markers such as NLRP3 inflammasome activity, others failed to demonstrate significant reductions in reperfusion injury events or infarct size. Notably, the COVERT-MI trial revealed an unexpected threefold increase in left ventricular thrombus formation with colchicine therapy, raising safety concerns. Gastrointestinal side effects were also consistently reported across studies. The evidence suggests that the anti-inflammatory properties of colchicine may not translate into clinically meaningful cardioprotection in the acute phase of STEMI. Current data do not support routine colchicine administration for reperfusion injury reduction in STEMI patients undergoing primary percutaneous coronary intervention, highlighting the need for larger, well-designed trials with standardized protocols and longer follow-up periods to definitively establish its role in acute myocardial infarction management.

Keywords: colchicine; inflammasome; ischemia-reperfusion; left ventricular thrombus; primary percutaneous coronary intervention; reperfusion injury; st-segment elevation myocardial infarction.

Figure 1. PRISMA diagram showing the study selection process

PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses