Colchicine did not significantly reduce perioperative atrial fibrillation (AFib) or myocardial injury following major noncardiac thoracic surgery, according to results from the COP-AF trial presented at ESC Congress 2023 and simultaneously published in The Lancet.

Researchers randomized 3,209 patients aged 55 years or older who were undergoing major noncardiac thoracic surgery to receive either oral colchicine (0.5mg twice daily) or matching placebo, starting within four hours before surgery and for a total duration of 10 days. Participants were from 45 sites in 11 countries and the mean age was 68 years and 48.4% were women. The primary outcomes of clinically important perioperative AFib and myocardial injury were assessed during 14 days of follow-up.

Overall results found clinically important AFib developed in 103 of 1,608 (6.4%) patients assigned to colchicine compared with 120 of 1,601 (7.5%) patients assigned to placebo. Myocardial injury occurred in 295 (18.3%) patients assigned to colchicine and 325 (20.3%) patients assigned to placebo. Researchers noted no significant differences between treatment groups in key secondary outcomes, including the composite of all-cause mortality, nonfatal myocardial injury and nonfatal stroke.

In post-hoc analyses, the composite outcome of clinically important perioperative AFib or myocardial injury occurred in 360 (22.4%) patients receiving colchicine and in 415 (25.9%) patients receiving placebo. The composite outcome of vascular mortality, nonfatal myocardial injury, nonfatal stroke or clinically important perioperative AFib occurred in 364 (22.6%) patients in the colchicine group compared with 422 (26.4%) in the placebo. One patient (0.1%) in the colchicine group and five (0.3%) in the placebo group experienced a stroke.

From a safety perspective, the composite outcome of sepsis or infection occurred in 103 (6.4%) patients in the colchicine group and 83 (5.2%) patients in the placebo group. Colchicine also increased the incidence of non-infectious diarrhea (134 (8.3%) vs. 38 (2.4%) patients), but researchers noted these episodes were temporary and benign.

"Despite these findings, several results provide an encouraging signal of benefit for colchicine to reduce the incidence of adverse cardiovascular outcomes in patients undergoing major noncardiac thoracic surgery," said David Conen, MD, of the Population Health Research Institute, Hamilton, Canada. "Future trials should further investigate the role of colchicine in the prevention of these events in patients undergoing surgery."

Clinical Topics: Arrhythmias and Clinical EP, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Atrial Fibrillation/Supraventricular Arrhythmias, Cardiac Surgery and Arrhythmias

Keywords: ESC Congress, ESC23, ACC International, Colchicine, Atrial Fibrillation, Cardiac Surgical Procedures

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