COLCOT: what the trial showed

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. Results are summarized from the cited trial report and any companion publications listed below.

At a glance

Primary outcome

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

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

• Does low-dose colchicine reduce cardiovascular events in coronary disease?Yes — roughly a quarter to a third fewer ischaemic events in two randomised trials, on top of standard therapy.

Written for healthcare professionals as an orientation to the primary publication, not as a substitute for reading it. For literature search, education, and professional evidence review only. Not for diagnosis, treatment selection, triage, monitoring, prognosis, or patient-specific clinical decision-making.