Effect of Low-Dose Colchicine on Inflammatory Markers Following Acute Myocardial Infarction: A Single-Centre, Double-Blind, Randomized Controlled Trial

Abstract

Background: Residual inflammatory risk after acute myocardial infarction (AMI) continues to drive recurrent ischaemic events despite optimal lipid-lowering and antithrombotic therapy. Low-dose colchicine has emerged as an inexpensive, widely available antiinflammatory agent with growing evidence in secondary cardiovascular prevention, although data from Middle Eastern and North African populations remain limited. The present trial evaluated the effect of low-dose colchicine on inflammatory markers, ventricular function, and short-term clinical outcomes in Egyptian patients with recent AMI. Methods: A singlecentre, prospective, double-blind, placebo-controlled randomized trial was conducted between March 2024 and February 2025. A total of 160 patients with ST-elevation or nonST-elevation AMI were enrolled within 72 hours of the index event and randomly allocated 1:1 to colchicine 0.5 mg once daily or matching placebo, in addition to guideline-directed medical therapy, for 12 weeks. The primary endpoint was the absolute change in highsensitivity C-reactive protein (hs-CRP) from baseline to week 12. Secondary endpoints included interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), neutrophil-to-lymphocyte ratio (NLR), left ventricular ejection fraction (LVEF) and a composite of major adverse cardiovascular events (MACE). Results: Baseline characteristics were comparable between groups. At 12 weeks, hs-CRP fell by 4.18 ± 1.27 mg/L in the colchicine group versus 1.92 ± 1.04 mg/L in the placebo group (p < 0.001). IL-6 (–3.42 vs –1.18 pg/mL; p < 0.001), TNF-α (–4.86 vs –1.74 pg/mL; p < 0.001) and NLR (–1.86 vs –0.71; p < 0.001) showed parallel reductions. LVEF improved by 5.6 ± 3.2% versus 2.9 ± 2.8% (p < 0.001). MACE occurred in 5.0% versus 12.5% of patients (p = 0.084). Gastrointestinal symptoms were the commonest adverse events (11.3% vs 3.8%; p = 0.057), all transient and not requiring permanent discontinuation in the majority. Conclusion: Twelve weeks of low-dose colchicine produced a significant reduction in inflammatory markers and a modest improvement in left ventricular function after AMI in an Egyptian cohort, supporting its role as an affordable adjunct in contemporary post-infarction care.