Colchicine does not significantly reduce perioperative atrial fibrillation or myocardial injury in patients undergoing major noncardiac thoracic surgery.

 Treatment with colchicine did not significantly reduce atrial fibrillation (AF) or myocardial injury after noncardiac surgery (MINS) in patients undergoing major noncardiac thoracic surgery. However, the authors observed a consistent trend indicating that fewer cardiovascular events occurred in patients treated with this agent and suggest that further research should be conducted.

“Perioperative AF and MINS are prognostically important adverse outcomes after major thoracic surgery,” outlined David Conen, MD, MPH, at ESC Congress 2023. 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 noncardiac thoracic surgery. The phase 3 COP-AF trial randomly assigned 3,209 patients of at least 55 years of age who were scheduled for noncardiac thoracic surgery with general anesthesia 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, there was no significant difference 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 favored the colchicine arm over the placebo arm but failed to display significant differences.

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

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