Original title: Colchicine Treatment for the Prevention of Bare-Metal Stent Restenosis in Diabetic Patients. Reference: Spyridon Deftereos et al. J Am Coll Cardiol 2013;61:1679–85.
In stent restenosis is more frequent in diabetic patients, who therefore find DES particularly beneficial. However, there is a subset of these patients with contraindication to prolonged double antiaggregation, due to a programmed surgery or to high risk of bleeding. Colchicine is drug known for its anti-proliferative and anti-inflammatory effects, which in theory could lead to decreased rates of in stent restenosis This study tested the effect of colchicine on neointima formation in diabetic patients who received bare metal stents (BMS). It was a double blind prospective control study with placebo. Eligible patients were diabetics with DES contraindication receiving BMS in coronary arteries of at least 2.5 mm diameter
All angioplasty studies were made by intravascular ultrasound (IVUS), using the images to optimize expansion and apposition. Angiography and IVUS follow up was done at 6 months after procedure, with in stent restenosis as primary end point. It included 196 diabetic patients with DES contraindication randomized 1:1 to colchicines or placebo. Baseline characteristics of the population were well balanced between the two branches. Angiographic binary restenosis was 52% lower in the colchicine group (OR 0.38, IC 0.18 to 0.79). IVUS studies rendered similar results with a decrease in relative risk (44% OR 0.42, IC 0.22 to 0.81). Late lumen loss was 1.6 mm² for the colchicine group vs. 2.9 mm² for the control group (p=0.002). There were no differences in clinical end points.
Conclusion:
Colchicine is associated with less neointimal hyperplasia and a reduction of in stent restenosis when administered in diabetic patients receiving conventional stents. This information can be useful for diabetic patients with DES contraindication.
Editorial comment:
The end points were not clinical; it might be interesting to carry out a study with more patients to confirm data since prolonged antiaggregation contraindication is a relatively frequent situation. An important difference was observed between binary restenosis and target lesion revascularization. (24% vs 4%), this could be explained by the frequency of silent ischemia in diabetics, medical treatment optimization and also because most of restenosis (66.7%) were less severe (less than 70%).
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