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=Volume 11 - 2024

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=Background: 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.
Objectives: To investigate the effects of colchicine versus aspirin on inflammation and platelet reactivity in patients with acute coronary syndrome (1) undergoing PCI.
Methods: This observational study compared laboratory measurements in ACS patients receiving single antiplatelet therapy with ticagrelor or prasugrel plus colchicine (MACT) (n=185) versus conventional dual-antiplatelet therapy (DAPT) with aspirin plus ticagrelor or prasugrel (n=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.
Results: 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, p<0.001). The frequency of high residual inflammation was also lower in the MACT group (10.8% vs. 27.2%, p<0.001) (odds ratio [95% confidence interval] =0.33 [0.20-0.54], p<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 P2Y12 reaction unit [PRU] measured by VerifyNow, p=0.776).
Conclusions: In ACS patients undergoing PCI, MACT was associated with a lower rate of high residual inflammation without increasing platelet reactivity compared to conventional DAPT.