Highlights
Colchicine did not reduce the risk of clinically important atrial fibrillation or myocardial injury before and 10 days after major thoracic surgery. If surgical patients are at high risk for atrial fibrillation or ischemic events, “it would not seem unreasonable to consider[colchicine],” the researchers said. The COP-AF trial included 3,209 patients who received non- Heart surgery with general anesthesia. Colchicine reduces perioperative atrial fibrillation and myocardial injury in procedures performed in thoracoscopic noncardiac surgery. Subgroup analyzes suggest that colchicine reduces the relative risk of clinically important atrial fibrillation during thoracoscopic noncardiac surgery. Colchicine has been shown to reduce the risk of major cardiovascular events in patients with chronic coronary artery disease. The COP-AF study was originally planned to investigate the effect of colchicine on perioperative AF, but following the publication of LoDoCo2 and COLCOT, myocardial injury after noncardiac surgery (MINS) was included as a separate co-primary endpoint. Perioperative AF and MINS are common clinical outcomes after noncardiac surgery and are associated with poor outcomes. The primary endpoint of the COP-AF trial was perioperative clinically important AF, defined as AF leading to angina, heart failure, or symptomatic hypotension, or requiring the use of drugs or electrical conversion. Daily troponin measurements were performed within 3 postoperative days, while rhythm monitoring was performed as per standard of care. Treatment with colchicine on the safety side increased the risk of diarrhea, but these events did not prolong the median length of hospital stay and resulted in only one readmission. The results showed that colchicine had no significant effect in non-thoracoscopic surgery, but reduced perioperative atrial fibrillation and myocardial injury in thoracoscopic surgery. The results of the COP-AF trial suggest a “potential” benefit. This subgroup is also a more clinically relevant population because thoracoscopic surgery is more common. The study, conducted to investigate the effect of colchicine on atrial fibrillation and myocardial injury after noncardiac surgery, demonstrates some potential benefits of using colchicine in thoracoscopic noncardiac surgery.
in conclusion
The COP-AF trial showed that administration of colchicine before and 10 days after major thoracic surgery did not reduce the risk of clinically important atrial fibrillation or myocardial injury. While there are some potential benefits, they are not yet large enough to broadly change physician practice. If surgical patients are at high risk for atrial fibrillation or ischemic events, “it would not seem unreasonable to consider (colchicine).”
2023-08-25 22:42:19
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