Aernoud Fiolet

216 Chapter 8 ABSTRACT Background. Colchicine reduces risk of cardiovascular events in patients post myocardial infarction and in patients with chronic coronary disease. It remains unclear whether this effect is related to the time of onset of treatment following an acute coronary syndrome (ACS). Objectives. This study investigates risk for major adverse cardiovascular events in relation to history and timing of prior ACS, to determine whether the benefits of colchicine are consistent independent of prior ACS status. Methods. The Low-Dose Colchicine 2 trial randomly allocated patients with chronic coronary disease to colchicine 0.5mg once daily or placebo. The rate of the composite of cardiovascular death, spontaneous myocardial infarction, ischemic stroke, or ischemia-driven coronary revascularization was compared between patients with no prior, recent (6-24 months), remote (2-7 years) or very remote (>7 years) ACS; interaction between ACS status and colchicine treatment effect was assessed. Results. In 5,522 randomized patients, risk of the primary end point was independent of prior ACS status. Colchicine consistently reduced the primary end point in patients with no prior ACS (incidence: 2.8 vs. 3.4 events per 100 person- years, hazard ratio [HR]: 0.81; 95% confidence interval [CI]: 0.52-1.27), recent ACS (incidence: 2.4 vs. 3.3 events per 100 person-years, HR: 0.75; 95% CI: 0.51- 1.10), remote ACS (incidence: 1.8 vs. 3.2 events per 100 person-years, HR: 0.55; 95% CI: 0.37-0.82), and very remote ACS (incidence: 3.0 vs. 4.3 events per 100 person-years, HR: 0.70; 95% CI: 0.51-0.96; p interaction 0.590). Conclusions. The benefits of colchicine are consistent irrespective of history and timing of prior ACS.