Optical coherence tomography assessment of the impact of colchicine on non-culprit coronary plaque composition after myocardial infarction
Date
2025
Authors
Psaltis, P.J.
Nguyen, M.T.
Singh, K.
Sinhal, A.
Wong, D.T.L.
Alcock, R.
Rajendran, S.
Dautov, R.
Barlis, P.
Patel, S.
Editors
Advisors
Journal Title
Journal ISSN
Volume Title
Type:
Journal article
Citation
Cardiovascular Research (CVR), 2025; 121(3):468-478
Statement of Responsibility
Peter J. Psaltis, Mau T. Nguyen, Kuljit Singh, Ajay Sinhal, Dennis T.L. Wong, Richard Alcock, Sharmalar Rajendran, Rustem Dautov, Peter Barlis, Sanjay Patel, Thalia Salagaras, Jessica A. Marathe, Christina A. Bursill, Nicholas J. Montarello, Stefan M. Nidorf, Peter L. Thompson, Julie Butters, Alana R. Cuthbert, Lisa N. Yelland, Juanita L. Ottaway, Yu Kataoka, Giuseppe Di Giovanni, and Stephen J. Nicholls
Conference Name
Abstract
Aims: Low-dose colchicine reduces the risk of cardiovascular events after myocardial infarction (MI). The purpose of this study was to assess the effect of colchicine post-MI on coronary plaque morphology in non-culprit segments by optical coherence tomography (OCT). Methods and results: COCOMO-ACS was a double-blind, placebo-controlled trial that randomized 64 patients (median age 61.5 years; 9.4% female) with acute non-ST-segment elevation MI to colchicine 0.5 mg daily or placebo for a median of 17.8 months in addition to guideline-recom mended therapy. Participants underwent serial OCT imaging within a matched segment of non-culprit coronary artery that contained at least one lipid-rich plaque causing ≥20% stenosis. The primary outcome was the change in minimum fibrous cap thickness (FCT) in non-culprit segments from baseline to final visit. Of those randomized, 57 (29 placebo, 28 colchicine) had evaluable imaging at baseline and follow-up. Overall, colchicine had no effect on relative (placebo +48.0 ± 35.1% vs. colchicine +62.4 ± 38.1%, P = 0.18) or absolute changes in minimum FCT (+29.2 ± 20.9 µm vs. + 37.2 ± 21.3 µm, P = 0.18), or change in maximum lipid arc (−38.8 ± 32.2° vs. −54.8 ± 46.9°, P = 0.18) throughout the imaged non-culprit segment. However, in patients assigned colchi cine, cap rupture was less frequent (placebo 27.6% vs. colchicine 3.6%, P = 0.03). In post hoc analysis of 43 participants who had been followed for at least 16 months, minimum FCT increased to a greater extent in the colchicine group (placebo +38.7 ± 25.4% vs. colchicine +64.7 ± 34.1%, P = 0.005). Conclusion: In this study, OCT failed to detect an effect of colchicine on the minimum FCT or maximum lipid arc of plaques in non-culprit segments post-MI. The post hoc observation that minimum FCT increased to a greater extent with colchicine after more prolonged treatment suggests that longer-term studies may be required to detect the effect of anti-inflammatory therapies on plaque morph ology by OCT.
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Online publish-ahead-of-print 27 August 2024
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© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.