医学
秋水仙碱
冠状动脉疾病
经皮冠状动脉介入治疗
内科学
心肌梗塞
心脏病学
不利影响
急性冠脉综合征
作者
Guillaume Marquis‐Gravel,Shaun G. Goodman,Todd J. Anderson,Alan Bell,David Bewick,Jafna L. Cox,Jean Grégoire,Anil Gupta,Thao Huynh,Heather Kertland,Simon Kouz,Philippe L. L’Allier,Mina Madan,G.B. John Mancini,Ruth McPherson,Derek So,Robert C. Welsh,Graham C. Wong,Jean‐Claude Tardif
标识
DOI:10.1016/j.cjca.2021.08.009
摘要
A better understanding of the central role of inflammation in the development of coronary artery disease (CAD) has been the impetus for the evaluation of therapeutic strategies targeting the interleukin-1ß/interleukin-6 cytokine signaling pathway, involved in both chronic atherogenesis and in triggering of atherosclerotic plaque rupture. As an inexpensive pharmacologic agent with relatively few adverse effects that tend to be mild and tolerable, the role of colchicine in secondary prevention of atherothrombotic events has been the focus of multiple recent large-scale randomized controlled trials involving patients with stable CAD (Low-Dose Colchicine [LoDoCo] and LoDoCo2 trials), a recent myocardial infarction (Colchicine Cardiovascular Outcome Trial [COLCOT], Colchicine in Patients With Acute Coronary Syndrome [COPS], and Colchicine and Spironolactone in Patients With Myocardial Infarction/Synergy Stent Registry [CLEAR SYNERGY] trials), and undergoing percutaneous coronary interventions (Colchicine in Percutaneous Coronary Intervention [COLCHICINE-PCI] trial). Based on this evidence, low-dose colchicine (0.5 mg once daily) should be considered in patients with recent myocardial infarctions-within 30 days and, ideally, within 3 days-or with stable CAD to improve cardiovascular outcomes. Colchicine should not be used in patients with severe renal or hepatic disease because of the risk of severe toxicity. No serious adverse effect was associated with the combined use of colchicine and high-intensity statin therapy in large trials. The impact of colchicine in high-risk populations of patients with peripheral arterial disease and in those with diabetes for the primary prevention of CAD remains to be established.
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