A recent large real-world cohort
showed a trend toward reduced cardiovascular outcomes in patients with
myocardial infarction with non-obstructive coronary arteries (MINOCA) who were
on colchicine.

A
portion of this work was presented at the 2025 American College of Cardiology
Annual Scientific Session. The findings are published in the American Heart Journal Plus: Cardiology
Research and Practice in December 2025.

The Unmet Clinical Need in Myocardial
infarction with nonobstructive coronary arteries (MINOCA)

Myocardial infarction with nonobstructive coronary arteries
(MINOCA) accounts for 5%–15% of all acute myocardial infarctions and represents
a heterogeneous clinical syndrome. Defined by MI occurring in patients with
<50% coronary stenosis and no alternative cause for myocardial injury,
MINOCA carries higher cardiovascular morbidity and mortality than the general
population, yet lacks disease-specific pharmacotherapy. Current treatment is
largely extrapolated from obstructive MI despite limited evidence. Growing data
highlight inflammation as a key mechanistic driver—supported by elevated
markers such as C-reactive protein and NOD-like Receptor Protein 3 (NLRP3)
inflammasome activation—which are linked to worse outcomes.

Study Overview

This retrospective cohort study used
the TriNetX network, accessing de-identified EHR data from ~134 million
patients across 102 healthcare organizations, to evaluate whether inflammation
reduction benefits MINOCA patients. Adults aged 18–80 years with AMI who
underwent catheterization without revascularization were included, while those
with alternative causes of troponin elevation (e.g., Takotsubo syndrome,
myocarditis, severe sepsis) were excluded to reduce misclassification.
Colchicine exposure was defined as a documented prescription started during or
after the index hospitalization and continued for at least one year. Using
extensive 1:1 propensity-score matching, the study balanced demographics,
cardiovascular risk factors, comorbidities, and inflammatory biomarkers,
yielding 1188 colchicine users matched to 1188 controls. The primary outcome
was a five-year composite of recurrent AMI, all-cause mortality,
cerebrovascular events, and all-cause hospitalizations.

Key Findings – Significant Reduction
in Hard Cardiovascular Endpoints

The
analysis demonstrated favorable results for patients receiving colchicine:

•
Primary Composite Outcome: The
combined endpoint of recurrent AMI, all-cause mortality, cerebrovascular
events, and all-cause hospitalizations was significantly lower in the colchicine group compared to controls
(49.0% vs 55.1%).

•
Recurrent MI and Mortality:
Among secondary outcomes, the risk of AMI
recurrence was significantly lower, and all-cause mortality was dramatically reduced in the colchicine
arm.

•
Trends: Heart failure events (HR
0.861) and all-cause hospitalizations (HR 0.892) showed a clinical trend toward
lower rates with colchicine, though these differences did not reach statistical
significance.

•
Cerebrovascular Events: There
was no difference observed in
cerebrovascular events between the two groups.

Clinical Implications and
Opportunities for Future Research

The
finding that colchicine is associated with reduced cardiovascular morbidity and
mortality in MINOCA provides a crucial signal for clinicians managing this
complex patient group. Colchicine, acting as an NLRP3 inflammasome inhibitor, dampens vascular inflammation,
limits leukocyte–endothelial adhesion, and improves microvascular flow. The
observed benefit strongly supports the hypothesis that anti-inflammatory
effects are critical in MINOCA pathophysiology, which involves endothelial
injury, coronary vasospasm, and microvascular obstruction. Since MINOCA
patients often have elevated systemic inflammatory markers, colchicine’s
actions offer a coherent biological mechanism for improving outcomes. While
this real-world retrospective study cannot establish causality, the results
strongly suggest that colchicine, an accessible medication, should be further
investigated as a potential targeted
therapeutic strategy. These findings are hypothesis-generating and warrant confirmation in prospective,
mechanism-specific clinical trials to further substantiate colchicine’s
potential role in the secondary prevention of MINOCA.

Reference: Oro P, Vignarajah A, El Dahdah J, Vigneswaramoorthy N, Awakeem
Y, Shah GV. Colchicine and cardiovascular outcomes in MINOCA: A retrospective
cohort study. Am Heart J Plus. 2025 Oct 15;60:100643. doi:
10.1016/j.ahjo.2025.100643. PMID: 41146862; PMCID: PMC12554186.

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