AUTHOR=Lee Seung-Yul , Cho Jae Young , Gorog Diana A. , Angiolillo Dominick J. , Yun Kyeong Ho , Ahn Jong-Hwa , Koh Jin-Sin , Park Yongwhi , Hwang Seok-Jae , Hwang Jin-Yong , Kim Jin Won , Jang Yangsoo , Jeong Young-Hoon 

TITLE=Inflammation and platelet reactivity during adjunctive colchicine versus aspirin in patients with acute coronary syndrome treated with potent P2Y12 inhibitor

JOURNAL=Frontiers in Medicine

VOLUME=11

YEAR=2024

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1349577

DOI=10.3389/fmed.2024.1349577

ISSN=2296-858X

ABSTRACT=<sec id="sec1"><title>Background</title><p>In patients undergoing percutaneous coronary intervention (PCI), the use of anti-inflammatory therapy with colchicine is associated with a reduction of recurrent ischemic events. The mechanisms of such findings are not fully elucidated.</p></sec><sec id="sec2"><title>Objectives</title><p>To investigate the effects of colchicine versus aspirin on inflammation and platelet reactivity in patients with acute coronary syndrome (ACS) undergoing PCI.</p></sec><sec id="sec3"><title>Methods</title><p>This observational study compared laboratory measurements in ACS patients receiving single antiplatelet therapy with ticagrelor or prasugrel plus colchicine (MACT) (<italic>n</italic> = 185) versus conventional dual-antiplatelet therapy (DAPT) with aspirin plus ticagrelor or prasugrel (<italic>n</italic> = 497). The primary outcome was the frequency of high residual inflammation, defined as high-sensitivity C-reactive protein (hs-CRP) ≥2 mg/L at 1 month post-PCI. Multiple sensitivity analyses were performed for the primary outcome, including multivariable adjustment, propensity-score matching, and inverse-probability weighted methods.</p></sec><sec id="sec4"><title>Results</title><p>One month after PCI, patients treated with MACT had significantly lower levels of hs-CRP compared to those treated with DAPT (0.6 [0.4–1.2] vs. 0.9 [0.6–2.3] mg/L, <italic>p</italic> &lt; 0.001). The frequency of high residual inflammation was also lower in the MACT group (10.8% vs. 27.2%, <italic>p</italic> &lt; 0.001) (odds ratio [95% confidence interval] = 0.33 [0.20–0.54], <italic>p</italic> &lt; 0.001). This effect was consistent across sensitivity analyses. There was no difference in platelet reactivity between MACT and DAPT (49.6 ± 49.0 vs. 51.5 ± 66.4 P2Y<sub>12</sub> reaction unit [PRU] measured by VerifyNow, <italic>p</italic> = 0.776).</p></sec><sec id="sec5"><title>Conclusion</title><p>In ACS patients undergoing PCI, MACT was associated with a lower rate of high residual inflammation without increasing platelet reactivity compared to conventional DAPT.</p></sec><sec id="sec6"><title>Clinical trial registration</title><p>NCT04949516 for MACT pilot trial and NCT04650529 for Gyeongsang National University Hospital registry.</p></sec>