Clinical Efficacy and Safety of Colchicine in Patients with Acute Myocardial Infarction: An Updated Meta-Analysis of Randomized Controlled Trials

Abstract

Objectives: This updated meta-analysis evaluates the clinical efficacy and safety of Colchicine in patients with acute myocardial infarction (MI) by pooling data from randomized controlled trials (RCTs). Methodology: A comprehensive literature search was conducted for RCTs investigating colchicine use in MI patients from inception to February 2025. The primary outcome was the incidence of CV-related adverse events. Secondary outcomes included all-cause mortality, CV-related mortality, adverse gastrointestinal (GI) events, recurrent MI, cardiac arrest, hospitalization urgency, stroke, and high-sensitivity C-reactive protein (hs-CRP) levels. Pooled odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using random-effects model. Heterogeneity was assessed using I² statistics. Results: Twelve RCTs with 14,198 patients were analyzed. Colchicine significantly reduced CV-related adverse events (OR: 0.76; 95% CI: 0.59–0.96; p=0.02; I²=57%) and hospitalization urgency (OR: 0.32; 95% CI: 0.20–0.52; p<0.00001; I²=0%). However, it did not significantly impact all-cause mortality (OR: 0.93; 95% CI: 0.78–1.12; p=0.45; I²=0%) or CV-related mortality (OR: 0.97; 95% CI: 0.77–1.22; p=0.78; I²=0%). Colchicine use was associated with increased adverse GI events (OR: 1.79; 95% CI: 1.12–2.86; p=0.01; I²=78%) and significantly reduced hs-CRP levels (MD: -0.95; 95% CI: -1.46 to -0.43; p=0.0004; I²=89%). There was no significant effect on recurrent MI (OR: 0.85; 95% CI: 0.70–1.03; p=0.11; I²=3%), cardiac arrest (OR: 0.80; 95% CI: 0.33–1.96; p=0.63; I²=0%), or stroke (OR: 0.80; 95% CI: 0.31–2.06; p=0.65; I²=62%). Conclusion: These findings support the potential role of colchicine in MI management but highlight the need for careful patient selection and monitoring.