Aims Low-dose colchicine reduces the risk of cardiovascular events after myocardial infarction (MI). The purpose of this study was to assess the effect of colchicine post-MI on coronary plaque morphology in non-culprit segments by optical coherence tomography (OCT). Methods and results COCOMO-ACS was a double-blind, placebo-controlled trial that randomized 64 patients (median age 61.5 years; 9.4% female) with acute non-ST-segment elevation MI to colchicine 0.5 mg daily or placebo for a median of 17.8 months in addition to guideline-recommended therapy. Participants underwent serial OCT imaging within a matched segment of non-culprit coronary artery that contained at least one lipid-rich plaque causing ≥20% stenosis. The primary outcome was the change in minimum fibrous cap thickness (FCT) in non-culprit segments from baseline to final visit. Of those randomized, 57 (29 placebo, 28 colchicine) had evaluable imaging at baseline and follow-up. Overall, colchicine had no effect on relative (placebo +48.0 ± 35.1% vs. colchicine +62.4 ± 38.1%, P = 0.18) or absolute changes in minimum FCT (+29.2 ± 20.9 µm vs. + 37.2 ± 21.3 µm, P = 0.18), or change in maximum lipid arc (−38.8 ± 32.2° vs. −54.8 ± 46.9°, P = 0.18) throughout the imaged non-culprit segment. However, in patients assigned colchicine, cap rupture was less frequent (placebo 27.6% vs. colchicine 3.6%, P = 0.03). In post hoc analysis of 43 participants who had been followed for at least 16 months, minimum FCT increased to a greater extent in the colchicine group (placebo +38.7 ± 25.4% vs. colchicine +64.7 ± 34.1%, P = 0.005). Conclusion In this study, OCT failed to detect an effect of colchicine on the minimum FCT or maximum lipid arc of plaques in non-culprit segments post-MI. The post hoc observation that minimum FCT increased to a greater extent with colchicine after more prolonged treatment suggests that longer-term studies may be required to detect the effect of anti-inflammatory therapies on plaque morphology by OCT. Clinical trial number Australian New Zealand Clinical Trials Registry Identifier, ACTRN12618000809235, registered on the 11 May 2018.

中文翻译：

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秋水仙碱对心肌梗死后非罪魁祸首冠状动脉斑块组成影响的光学相干断层扫描评估


目的 低剂量秋水仙碱可降低心肌梗死 （MI） 后发生心血管事件的风险。本研究的目的是通过光学相干断层扫描 （OCT） 评估秋水仙碱 MI 后对非罪魁祸首节段冠状动脉斑块形态的影响。方法和结果COCOMO-ACS 是一项双盲、安慰剂对照试验，将 64 例急性非 ST 段抬高型心肌梗死患者 （中位年龄 61.5 岁;9.4% 为女性） 随机分配至秋水仙碱 0.5 mg /d 或安慰剂组，中位治疗时间为 17.8 个月，此外还遵循指南推荐的治疗。参与者在非罪魁祸首冠状动脉的匹配段内接受了连续 OCT 成像，该段包含至少一个导致 ≥20% 狭窄的富含脂质的斑块。主要结局是非罪魁祸首节段最小纤维帽厚度 （FCT） 从基线到最终就诊的变化。在随机分组的患者中，57 例 （29 例安慰剂，28 例秋水仙碱） 在基线和随访时进行了可评估的影像学检查。总体而言，秋水仙碱对相对 （安慰剂 +48.0 ± 35.1% vs. 秋水仙碱 +62.4 ± 38.1%，P = 0.18） 或最小 FCT 的绝对变化 （+29.2 ± 20.9 μm vs. + 37.2 ± 21.3 μm，P = 0.18） 或最大脂质弧的变化 （-38.8 ± 32.2° vs. -54.8 ± 46.9°，P = 0.18） 没有影响整个成像的非罪魁祸首段。然而，在分配秋水仙碱的患者中，菌帽破裂的频率较低 （安慰剂 27.6% vs. 秋水仙碱 3.6%，P = 0.03）。在对 43 名接受至少 16 个月随访的参与者的事后分析中，秋水仙碱组的最低 FCT 增加程度更高（安慰剂 +38.7 ± 25.4% vs. 秋水仙碱 +64.7 ± 34.1%，P = 0.005）。结论 在本研究中，OCT 未能检测到秋水仙碱对 MI 后非罪魁祸首节段斑块最小 FCT 或最大脂质弧的影响。 事后观察表明，在更长时间的治疗后，秋水仙碱的最低 FCT 增加的程度更大，这表明可能需要更长期的研究来检测抗炎疗法对 OCT 斑块形态的影响。临床试验编号澳大利亚新西兰临床试验注册标识符，ACTRN12618000809235，于 2018 年 5 月 11 日注册。