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AHA 2019: Colchicine in Percutaneous Coronary Intervention (PCI) Dr Binita Shah

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Dr Binita Shah (NYU Langone Health, New York, NY, US) discusses Colchicine in Percutaneous Coronary Intervention (PCI).

You so colchicine has been long used in the treatment of gout it’s an anti-inflammatory drug it’s been used for the treatment of gout and other inflammatory conditions such as familial mediterranean fever and it is a very it’s been because it’s been used for so long it’s tried and tested and has an excellent side effect safety profile in terms of its anti-inflammatory

Action the other thing we know is that colchicine it rapidly works works very quickly within a few hours of the actual insult to lower inflammatory symptoms and so we thought to then bring this over to the pci world we know that pci causes vascular inflammation causes myocardial injury we also know that improving inflammation after an mi improves outcomes but we

Have no currently available treatment options to rapidly reduce inflammation or vascular information and so colchicine is inexpensive yet a very potent anti-inflammatory agent and again with a very excellent side effect safety profile and our group has shown before that colchicine can reduce the attachment of inflammatory cells to ruptured or inflamed and öthey

Liam as well as platelets both of which are very active in both the acute coronary syndrome patients as well as in the pci population sure this we received funding from the va and the american heart association to conduct this single center randomized double-blind investigator-initiated study and we randomized patients to 1.8 milligrams of colchicine orally versus

Matching placebo one or two hours pre procedure in 400 patients who underwent pci the primary endpoint was a pci related myocardial injury and 30 and that one of the key secondary endpoints was 30-day major adverse cardiovascular events we had a nested biomarker sub study where we evaluated the primary endpoint of interleukin 6 in the change of interleukin 6 from

Baseline to post pci in both groups and key secondary endpoints there were il-1 beta as well as hsc rp so our results showed that a single shot of oral pre procedural colchicine did not reduce pci related myocardial injury or 30-day mace but it did reduce vast blood markers of vascular inflammation post procedure and so in actuality is the first study to show

That colchicine can prevent a rise in inflammation during any acute clinical injury so kolkata randomized patients within 30 days of an mi to daily use of low-dose colchicine for long term ours was a pre procedural one time shot you know before the actual insult and cold you see a kolkata demonstrated improvement in outcomes with the daily use so really more work

Is needed to figure out the optimal dosing and timing regimen of pre procedural colchicine in this pci population in our study we showed that colchicine attenuated markers of inflammation but they attenuated it almost 24 hours post pci and so an earlier start to this procedural colchicine regimen does warrant further investigation definitely we do need more work

In this area again trying to figure out when is the right time to give it what is the right dose our our patient population was very complex we had more than half of our patients had diabetes more than half presented with acute coronary syndrome perhaps we need a more potent dose of anti-inflammatory agent prior to the procedure and or should we be giving it much

Sooner should we be giving it about 12 hours before we go into the cath lab so a lot of more work is needed in that area as well clear synergy is run by dr. sangeeth jolly over at mcmasters and he is randomizing patients with st segment elevation in my within 24 within 48 hours of primary pci to either colchicine or matching placebo and i have nih funding to conduct

A biomarker sub study of this this large group and i think that’s also going to give us a lot more information the primary aims of my biomarker subsidy is not only to try to better understand the very complex role of inflammation because it’s very unclear right now as to why some drugs work and some drugs don’t but also to understand which patients may benefit

From anti-inflammatory treatment versus which patients will not benefit from anti-inflammatory treatment we really want to further advance the field of personalized medicine and hopefully the biomarker subsidy of clear synergy will provide some insight there

Transcribed from video
AHA 2019: Colchicine in Percutaneous Coronary Intervention (PCI) — Dr Binita Shah By Radcliffe