Cardiovascular

Colchicine to prevent cardiovascular events in thoracic surgery patients with or without coronary artery disease: a secondary analysis.

Razeghi G, Wang M, et al. • Open heart • 2026

PubMed 42744416 DOI 10.1136/openhrt-2026-004172

TL;DR

Patients with coronary artery disease undergoing thoracic surgery had a significantly higher risk of myocardial injury after non-cardiac surgery than non-CAD patients, but there was no evidence that the effect of colchicine differed between patients with and without CAD.

Key Findings

Results

Patients with CAD undergoing non-cardiac thoracic surgery had a significantly higher rate of myocardial injury after non-cardiac surgery (MINS) compared to those without CAD.

MINS occurred in 29.3% (n=97) of patients with CAD versus 18.2% (n=523) of patients without CAD.
Adjusted HR for MINS in CAD versus non-CAD patients was 1.53 (95% CI 1.22 to 1.92; p<0.001).
Of 3209 total patients enrolled, 331 (10.3%) had CAD.
Follow-up period was 14 days after surgery.

Results

Patients with CAD had a significantly higher rate of the composite outcome of death, MINS, and stroke compared to non-CAD patients.

The composite outcome occurred in 30.2% (n=100) of CAD patients versus 18.6% (n=535) of non-CAD patients.
Adjusted HR for the composite outcome was 1.53 (95% CI 1.22 to 1.91; p<0.001).
The composite outcome included death, MINS, and stroke assessed over a 14-day follow-up period.

Results

Colchicine did not show differential effects on MINS by CAD status, with no statistically significant interaction between CAD status and colchicine treatment.

For MINS, the HR for colchicine versus placebo was 0.82 (95% CI 0.55 to 1.22) in CAD patients and 0.91 (95% CI 0.77 to 1.08) in non-CAD patients.
The p-value for the interaction between CAD status and colchicine effect on MINS was 0.61.
Patients were randomized to colchicine 0.5 mg or placebo twice daily for 10 days.
The authors noted these analyses were limited by sample size and do not exclude modest differences between subgroups.

Results

Colchicine did not show differential effects on the composite outcome of death, stroke, or MINS by CAD status.

For the composite outcome, the HR for colchicine versus placebo was 0.77 (95% CI 0.52 to 1.14) in CAD patients versus 0.91 (95% CI 0.76 to 1.07) in non-CAD patients.
The p-value for the interaction between CAD status and colchicine effect on the composite outcome was 0.45.
This was a post hoc secondary analysis of the COP-AF (Colchicine for the Prevention of Perioperative Atrial Fibrillation) randomized controlled trial.

Methods

This study was an exploratory post hoc secondary analysis of the COP-AF randomized controlled trial, assessing outcomes over a 14-day follow-up period in thoracic surgery patients.

The parent trial (COP-AF) was designed to evaluate colchicine for prevention of perioperative atrial fibrillation, not specifically for ischaemic outcomes in CAD patients.
Cox proportional hazards models were used to assess associations between CAD and outcomes, with interaction terms to explore differential colchicine effects by CAD status.
The primary outcome of this secondary analysis was MINS, and a key secondary outcome was the composite of death, MINS, and stroke.
The analysis was limited by the relatively small number of CAD patients (n=331, 10.3% of the total cohort), which constrained statistical power.

What This Means

This research examined whether patients with pre-existing coronary artery disease (CAD) — blockages in the heart's arteries — face greater risks of heart-related complications after chest (thoracic) surgery compared to patients without CAD. It also investigated whether colchicine, an anti-inflammatory drug, might be especially helpful for CAD patients in this setting. The study analyzed data from over 3,200 patients who had participated in a larger clinical trial, of whom about 1 in 10 had CAD. This research suggests that having CAD roughly doubles the risk of myocardial injury (heart muscle damage detected by blood tests) and the combined risk of death, stroke, or heart muscle damage in the two weeks following thoracic surgery. Specifically, about 29% of CAD patients experienced myocardial injury compared to about 18% of non-CAD patients. Colchicine, taken twice daily for 10 days, appeared to show a trend toward reducing heart-related complications in both groups, but there was no clear evidence that it worked differently or better in CAD patients versus non-CAD patients. This research suggests that patients with CAD represent a higher-risk group for cardiovascular complications after thoracic surgery, which may warrant extra monitoring or preventive strategies. However, the study could not definitively determine whether colchicine provides greater benefit specifically for CAD patients, largely because the number of CAD patients in the study was relatively small. Larger studies would be needed to confirm whether colchicine has different effects based on CAD status.

Have a question about this study?

Citation

Razeghi G, Wang M, Devereaux P, Popova E, Chan M, Sessler D, et al.. (2026). Colchicine to prevent cardiovascular events in thoracic surgery patients with or without coronary artery disease: a secondary analysis.. Open heart. https://doi.org/10.1136/openhrt-2026-004172

Key Findings

What This Means

Have a question about this study?

Related Research

Citation