Does colchicine prevent perioperative AF and MINS?

Treatment with colchicine did not significantly reduce atrial fibrillation (AF) or myocardial injury after non-cardiac surgery (MINS) in patients undergoing major, non-cardiac, thoracic surgery. Interestingly, there was a hypothesis-generating observed interaction effect between surgical approach and received study drug on the occurrence of clinically important AF, with those undergoing thoracoscopic surgery experiencing benefit from colchicine, whereas those undergoing non-thoracoscopic surgery did not.

“Perioperative AF and MINS are prognostically important adverse outcomes after major thoracic surgery,” outlined Dr David Conen (McMaster University, Canada) [1]. Dr Conen and his co-investigators evaluated the effects of oral colchicine on the incidence of clinically important perioperative AF and MINS in patients undergoing major, non-cardiac, thoracic surgery. The phase 3 COP-AF trial (NCT03310125) randomised 3,209 participants of at least 55 years of age who were scheduled for non-cardiac thoracic surgery with general anaesthesia 1:1 to colchicine 0.5 mg, starting from 4 hours pre-surgery, then twice daily for 10 days, or a matching placebo.

Clinically important perioperative AF occurred in 6.4% and 7.5% of the participants in the colchicine and placebo arms, respectively (HR 0.85; 95% CI 0.65–1.10; P=0.22). Similarly, no significant difference was seen in the incidence of MINS between those who received colchicine and those who received a placebo (18.3% vs 20.3%; HR 0.89; 95% CI 0.76–1.05; P=0.16). Secondary efficacy outcome measures also numerically favoured the colchicine arm over the placebo arm but failed to display significant differences.

The occurrence of sepsis and infections was similar for participants on colchicine and those on placebo (6.4% vs 5.2%; HR 1.24; 95% CI 0.93–1.66; P=0.14). In contrast, non-infectious diarrhoea did appear more frequently in participants treated with the investigational agent (8.3% vs 2.4%; HR 3.64; 95% CI 2.54–5.22; P<0.001).

Finally, the authors reported a significant interaction effect between surgical approach and received study drug on the occurrence of clinically important AF (P_interaction<0.0001): those who received thoracoscopic surgery were less likely to experience clinically important AF if they were treated with colchicine instead of placebo (3.5% vs 6.5%; HR 0.53; 95% CI 0.36–0.77); if patients underwent non-thoracoscopic surgery, placebo appeared the preferred option in the prevention of clinically important AF (10.5% vs 16.0%; HR 1.59; 95% CI 1.07–2.35). This interaction is hypothesis generating and requires validation in future prospective studies.

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   1. Conen D, et al. Colchicine for the prevention of peri-operative atrial fibrillation after major thoracic surgery: the COP-AF trial. Hot Line Session 1, ESC Congress 2023, 25–28 August, Amsterdam, the Netherlands.

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Posted on 30 October 2023