Colchicine for Prevention of Post-Operative Atrial Fibrillation: A Meta-Analysis

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• 作者：Justin Z. Lee ; MD^a ; Nirmal Singh ; MD^a ; Carol L. Howe ; MD^b ; See-Wei Low ; MD^a ; Jennifer J. Huang ; DO^a ; Gilbert Ortega ; BS^c ; Kwan S. Lee ; MD^d ; ^{klee@shc.arizona.edu" class="auth_mail" title="E-mail the corresponding author} ; Anil Pandit ; MD^e
• 关键词：atrial fibrillation ; colchicine ; post-operative atrial fibrillation
• 刊名：JACC: Clinical Electrophysiology
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：2
• 期：1
• 页码：78-85
• 全文大小：890 K

文摘

This study sought to investigate the efficacy and safety of colchicine for prevention of post-operative atrial fibrillation.

Background

Proinflammatory processes induced during cardiac surgery may contribute toward post-operative atrial fibrillation (AF). Colchicine is a potent anti-inflammatory agent, which may have a role in post-operative AF prevention.

Methods

We searched PubMed, EMBASE, Web of Science, CINAHL, ClinicalTrials.gov, and the Cochrane Library databases for randomized controlled trials (RCT) comparing colchicine versus placebo for prevention of post-operative AF. The main outcome measure of interest was the development of AF within 12 months after cardiac surgery. The overall risk ratio (RR) for the development of post-operative AF was computed using a random-effects model.

Results

Data analyzed from 3 randomized studies with a total of 912 patients, where 457 patients received colchicine and 455 patients received placebo, showed that perioperative colchicine therapy was associated with a reduced incidence of post-operative AF (RR: 0.65; 95% confidence interval [CI]: 0.46 to 0.91; p < 0.01). Although colchicine therapy was associated with increased incidence of gastrointestinal intolerance (RR: 2.20; 95% CI: 1.31 to 3.70; p = 0.003), it was not associated with early treatment discontinuation (RR: 1.37; 95% CI: 0.95 to 1.96; p = 0.09).

Conclusions

In conclusion, current evidence suggests that colchicine therapy is efficacious for the prevention of post-operative AF, and may be considered as adjunctive prophylaxis. Further studies may be required to determine the optimal treatment protocol to reduce the incidence of gastrointestinal intolerance.