Does perioperative colchicine reduce postpericardiotomy syndrome following cardiac surgery?
The use of colchicine in the perioperative period decreases the incidence of postpericardiotomy syndrome after cardiac surgery with a number needed to treat (NNT) of 10. However, colchicine leads to adverse effects—specifically, gastrointestinal intolerance—and may not be tolerated during the vulnerable postoperative period. Findings in this study also suggest a role for colchicine in the prevention of postoperative atrial fibrillation, but this was not a primary outcome of this study and requires further investigation. (LOE = 1b)
Imazio M, Brucato A, Ferrazzi P, et al, for the COPPS-2 Investigators. Colchicine for prevention of postpericardiotomy syndrome and postoperative atrial fibrillation. JAMA 2014;312(10):1016-1023.
Randomized controlled trial (double-blinded)
Inpatient (any location) with outpatient follow-up
Postpericardiotomy syndrome is a common complication after cardiac surgery and is defined by the presence of 2 of the following 5 criteria: fever without another cause, pleuritic chest pain, friction rub, new or worsening pericardial effusion, or pleural effusion with elevation in C-reactive protein levels.
To test the theory that perioperative colchicine can prevent postpericardiotomy syndrome, these investigators randomized 360 patients undergoing cardiac surgery to receive either colchicine at 0.5 mg twice daily (once daily for those who weighed less than 70 kg) or matching placebo. The study medication was started at 48 hours to 72 hours prior to surgery and continued for 1 month following surgery. Baseline characteristics of the 2 groups were similar, with two thirds of the patients undergoing either heart valve surgery or coronary artery bypass graft surgery.
The primary analysis was by intention to treat, but a prespecified on-treatment analysis was also performed. The overall study drug discontinuation rate for this trial was high (20%). Postpericardiotomy syndrome occurred less frequently in the colchicine group than in the placebo group at 3-month follow-up (19% vs 29%; absolute difference 10%; NNT = 10).
Additionally, although no significant difference was detected in the primary analysis, the on-treatment analysis did show a decrease in postoperative atrial fibrillation in the colchicine group (27% vs 41%; absolute difference 14%; NNT = 7). Adverse events were significantly greater in the colchicine group (20% vs 12%; number needed to treat to harm = 12), mainly due to increased gastrointestinal intolerance, but there was no difference between the 2 groups in the rate of study drug discontinuation.
Dr. Kulkarni is an assistant professor of hospital medicine at Northwestern University in Chicago.