Role of Colchicine in Reducing Reperfusion Injury in STEMI Patients Who Undergo Primary Percutaneous Coronary Intervention: A Randomized Clinical Trial

Authors

  • Birry Karim 1. Doctoral Program in Medical Sciences, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia. 2. Division of Cardiology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
  • Idrus Alwi Division of Cardiology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Mohammad Yamin Division of Cardiology, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Merci Monica Pasaribu Department of Clinical Pathology, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
  • Kuntjoro Harimurti Division of Geriatric, Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Nafrialdi Nafrialdi Department of Pharmacology and Therapeutic, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
  • Taufik Indrajaya Division of Cardiology, Department of Internal Medicine, Faculty of Medicine Universitas Sriwijaya - Mohammad Hoesin Hospital, Palembang, Indonesia
  • Rivaldo Rivaldo Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia

Keywords:

Colchicine, inflammation, reperfusion injury, PPCI, STEMI

Abstract

Background: Inflammation plays a role in ST-segment elevation myocardial infarction (STEMI), especially in reperfusion injury (RI). Colchicine, an anti-inflammatory drug, can suppress inflammation during RI. We assessed the effectiveness of administering colchicine to STEMI patients undergoing primary percutaneous coronary intervention (PPCI) in suppressing RI events. Methods: This study was a randomized, double-blind, placebo-controlled clinical trial conducted in a multicenter manner at two hospitals in Jakarta with IKPP facilities from December 2022 to April 2023. STEMI patients that underwent PPCI received 2 mg of colchicine as a loading dose and a maintenance dose of 0.5 mg every 12 hours for two days or amylum at a similar dose. Patients were observed for RI events (low-flow thrombolysis in myocardial infarction (0–2) during angiography procedure, reperfusion arrhythmia, cardiogenic shock, or persistent chest pain). Results: Seventy-seven STEMI patients with a mean age of 55.2 ± 9.9 years underwent PPCI. Of these patients, 37 received colchicine, and 40 received a placebo. Most subjects were male (77.5%), suffered three-vessel disease (44.15%), and occlusion in left anterior descending coronary artery (53.24%). Colchicine was found to fail to reduce the incidence of ischemia-RI (51.5% vs. 42.4%; p = 0.437). Analysis of comorbidities (hypertension, chronic kidney disease, diabetes mellitus, and obesity) and angiography results (vessel disease, lesion diameter, and culprit artery) failed to demonstrate a statistical difference in RI. Side effects were similar in the colchicine and placebo groups (21.6% vs. 15%). Conclusion: Colchicine administration in STEMI patients undergoing PPCI failed to reduce RI.

References

Badan Penelitian dan Pengembangan Kesehatan. Laporan nasional RISKESDAS 2018. Kementerian Kesehatan Republik Indonesia; 2018.

Badan Penelitian dan Pengembangan Kesehatan. Laporan nasona RISKESDAS 2013. Lembaga Penerbit Balitbangkes; 2013.

Salari N, Morddarvanjoghi F, Abdolmaleki A, et al. The global prevalence of myocardial infarction: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2023 Apr 22;23(1):206.

Jayaraj JC, Davatyan K, Subramanian SS, et al. Epidemiology of myocardial infarction. In: Myocardial Infarction [Internet]. IntechOpen; 2018 [cited 2023 Sep 18]. Available from: https://www.intechopen.com/chapters/59778

Pedersen F, Butrymovich V, Kelbæk H, et al. Short- and long-term cause of death in patients treated with primary PCI for STEMI. J Am Coll Cardiol. 2014 Nov 18;64(20):2101–8.

McManus DD, Gore J, Yarzebski J, Spencer F, Lessard D, Goldberg RJ. Recent trends in the incidence, treatment, and outcomes of patients with ST and non-ST-segment acute myocardial infarction. Am J Med. 2011 Jan;124(1):40–7.

García-García C, Oliveras T, El Ouaddi N, et al. Short- and long-term mortality trends in STEMI-cardiogenic shock over three decades (1989–2018): The Ruti-STEMI-shock registry. J Clin Med. 2020 Jul 27;9(8):2398.

Fröhlich GM, Meier P, White SK, Yellon DM, Hausenloy DJ. Myocardial reperfusion injury: looking beyond primary PCI. Eur Heart J. 2013 Jun 14;34(23):1714–22.

Hausenloy DJ, Botker HE, Engstrom T, et al. Targeting reperfusion injury in patients with ST-segment elevation myocardial infarction: trials and tribulations. Eur Heart J. 2017 Apr 1;38(13):935–41.

Cowled P, Fitridge R. Pathophysiology of reperfusion injury. In: Fitridge R, Thompson M, editors. Mechanisms of vascular disease: A reference book for vascular specialists [Internet]. Adelaide (AU): University of Adelaide Press; 2011 [cited 2023 Dec 14]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK534267/

Shen S, Wang Z, Sun H, Ma L. Role of NLRP3 inflammasome in myocardial ischemia-reperfusion injury and ventricular remodeling. Med Sci Monit Int Med J Exp Clin Res. 2022 Jan 19;28:e934255-1-e934255-13.

Leung YY, Hui LLY, Kraus VB. Colchicine --- update on mechanisms of action and therapeutic uses. Semin Arthritis Rheum. 2015 Dec;45(3):341–50.

Deftereos SG, Beerkens FJ, Shah B, et al. Colchicine in cardiovascular disease: In-depth review. Circulation [Internet]. 2022 Jan 4 [cited 2023 Dec 15]; Available from: https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.121.056171

Di Stefano R, Di Bello V, Barsotti MC, et al. Inflammatory markers and cardiac function in acute coronary syndrome: difference between ST-segment elevation myocardial infarction (STEMI) and non-STEMI models. Biomed Pharmacother Biomedecine Pharmacother. 2009 Dec;63(10):773–80.

Ferdinandy P, Andreadou I, Baxter GF, et al. Interaction of cardiovascular nonmodifiable risk factors, comorbidities and comedications with ischemia/reperfusion injury and cardioprotection by pharmacological treatments and ischemic conditioning. Pharmacol Rev. 2023 Jan;75(1):159–216.

Ma Z, Chen J, Jin K, Chen X. Colchicine and coronary heart disease risks: A meta-analysis of randomized controlled clinical trials. Front Cardiovasc Med [Internet]. 2022 [cited 2023 Nov 13];9. Available from: https://www.frontiersin.org/articles/10.3389/fcvm.2022.947959

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Published

2025-04-15

How to Cite

Karim, B., Alwi, I., Yamin, M., Pasaribu, M. M., Harimurti, K., Nafrialdi, N., Indrajaya, T., & Rivaldo, R. (2025). Role of Colchicine in Reducing Reperfusion Injury in STEMI Patients Who Undergo Primary Percutaneous Coronary Intervention: A Randomized Clinical Trial. Acta Medica Indonesiana, 57(1), 11. Retrieved from https://actamedindones.org/index.php/ijim/article/view/2636

Issue

Vol. 57 No. 1 (2025): Acta Medica Indonesiana

Section

ORIGINAL ARTICLE

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