Table3_Colchicine efficacy comparison at varying time points in the peri-operative period for coronary artery disease: a systematic review and meta-analysis of randomized controlled trials.docx

ObjectivesOver the years, it has been found that colchicine offers substantial benefits in secondary prevention in patients with coronary artery disease (CAD). We studied the effects of colchicine timing because there are no guidelines about when to provide it during the perioperative period for patients with CAD.
MethodsUp to January 1, 2023, seven electronic literature databases were screened (including three English databases and four Chinese databases). Randomized controlled trials included only treatment with colchicine in the perioperative period of CAD. The Cochrane Evaluation Tool was used to judge the risk of bias in research. Statistical analysis was performed by Stata 16.0 software.
ResultsWe evaluated twelve studies that found colchicine to be effective in decreasing the occurrence of major adverse cardiac events (MACEs) (p < 0.00001), but it also raised the rate of adverse events (p = 0.001). Subgroup analysis showed the same benefit in lowering the incidence of MACE with continuous administration of a total daily dose of 0.5 mg postoperatively while minimizing drug-related side effects in the patients (p = 0.03). When it comes to preventing surgical stroke occurrences, postoperative administration is more effective (p = 0.006). While the effect of simultaneous preoperative and postoperative administration was marginally greater than other periods in reducing postoperative hs-CRP levels (p = 0.02).
ConclusionColchicine, a traditional anti-inflammatory drug, also reduces the risk of MACE by reducing inflammation after PCI. Administration at different periods had no significant effect on decreasing the occurrence of MACE, but when administered postoperatively, we advise continuous administration with a total daily dose of 0.5 mg to obtain the same benefit while minimizing the drug's side effects. Postoperative administration is the better measure to prevent postoperative stroke events. Due to the effective anti-inflammatory effect of colchicine, we recommend its use as early as possible in the perioperative period and its continued use at low doses in the postoperative period.

Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=316751, identifier CRD42022316751.

研究目的：多年来已有研究证实，秋水仙碱（colchicine）可对冠状动脉疾病（coronary artery disease, CAD）患者的二级预防提供显著获益。鉴于目前尚无针对CAD患者围手术期秋水仙碱给药时机的临床指南，本研究旨在探讨秋水仙碱不同给药时段的临床效应。
研究方法：截至2023年1月1日，本研究共检索7个电子文献数据库（包含3个英文数据库及4个中文数据库）。纳入的随机对照试验仅涉及CAD围手术期秋水仙碱治疗方案。采用Cochrane偏倚风险评估工具对纳入研究的偏倚风险进行评价。统计学分析采用Stata 16.0软件完成。
研究结果：本研究共纳入12项相关研究，结果显示秋水仙碱可有效降低主要不良心血管事件（major adverse cardiac events, MACEs）的发生风险（p < 0.00001），但同时也会增加不良事件的发生率（p = 0.001）。亚组分析表明，术后持续给予每日总剂量0.5mg的秋水仙碱，在降低MACE发生率的同时可最大程度减少患者的药物相关不良反应（p = 0.03）。在预防术后卒中事件方面，术后给药的效果更为显著（p = 0.006）。而术前联合术后给药在降低术后高敏C反应蛋白（high-sensitivity C-reactive protein, hs-CRP）水平方面的效果略优于其他给药时段（p = 0.02）。
研究结论：秋水仙碱作为经典抗炎药物，还可通过降低经皮冠状动脉介入治疗（percutaneous coronary intervention, PCI）术后的炎症反应，从而降低MACE发生风险。不同给药时段对降低MACE发生率无显著影响，但术后给予每日总剂量0.5mg的持续给药方案，可在保证同等获益的同时最小化药物不良反应。术后给药是预防术后卒中事件的更优策略。鉴于秋水仙碱具有确切的抗炎效应，我们建议在围手术期尽早启动秋水仙碱治疗，并在术后以低剂量持续给药。
系统评价注册：https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=316751，注册号为CRD42022316751。