# COLCOT: what the trial showed

Canonical page: https://cliniatlas.com/trials/colcot/

In 4,745 patients enrolled within 30 days of a myocardial infarction, colchicine 0.5 mg daily reduced a composite of ischaemic cardiovascular events from 7.1% to 5.5% over a median of 22.6 months, driven mainly by fewer strokes and urgent revascularisations, with a small excess of pneumonia.

**Main cited publication:** Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction. New England Journal of Medicine (2019). PMID 31733140. https://pubmed.ncbi.nlm.nih.gov/31733140/

## At a glance

- Design: Randomised, double-blind, placebo-controlled
- Population: 4,745 adults recruited within 30 days after a myocardial infarction
- Intervention: Colchicine 0.5 mg once daily
- Comparator: Placebo
- Follow-up: Median 22.6 months
- Registration: NCT02551094
- Funding: Government of Quebec and others

## Primary outcome

Composite of cardiovascular death, resuscitated cardiac arrest, myocardial infarction, stroke, or urgent hospitalisation for angina leading to coronary revascularisation.

- Colchicine 0.5 mg once daily: 5.5%
- Placebo: 7.1%
- Effect: Hazard ratio 0.77 (95% CI 0.61 to 0.96), P=0.02

## Key findings

- Component hazard ratios were 0.84 for cardiovascular death, 0.83 for resuscitated cardiac arrest, 0.91 for myocardial infarction, 0.26 (95% CI 0.10 to 0.70) for stroke, and 0.50 (95% CI 0.31 to 0.81) for urgent hospitalisation for angina leading to revascularisation.
- Only the stroke and urgent revascularisation components were individually significant; cardiovascular death and MI were not.
- The larger LoDoCo2 trial in chronic coronary disease later reported a consistent reduction in cardiovascular events.

## Harms and safety

- Pneumonia as a serious adverse event was more frequent with colchicine (0.9% versus 0.4%, P=0.03).
- Diarrhoea was reported in 9.7% with colchicine and 8.9% with placebo, not a significant difference.

## Limitations

- The primary composite includes urgent revascularisation, a softer endpoint that carried much of the effect.
- Median follow-up under two years; long-term safety of continuous colchicine is informed by other trials.
- Patients with severe renal or hepatic disease were excluded, which matters for colchicine dosing in practice.

## Where it sits in guidelines

The 2021 ESC cardiovascular prevention guideline states that low-dose colchicine may be considered in secondary prevention (class IIb). The 2024 ESC chronic coronary syndromes guideline strengthened this to should be considered (class IIa) for patients with atherosclerotic disease.

## CliniAtlas answers that use this trial

- https://cliniatlas.com/evidence/colchicine-secondary-prevention-coronary-disease/

Ask about this trial against live sources (free, no sign-in): https://cliniatlas.com/?q=What%20did%20the%20COLCOT%20trial%20show%20and%20how%20should%20it%20be%20interpreted%3F

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