The no-reflow phenomenon following PCI is associated with adverse outcomes. PODCAST-PCI is a prospective, single-center, randomized, double-blind, placebo-controlled study involving 451 patients in Iran with acute MI that aimed to demonstrate whether pre-procedural treatment with the anti-inflammatory medication, colchicine, resulted in reduction in frequency of the no-reflow phenomenon (NRP). Patients received guideline-directed therapy including clopidogrel, atorvastatin and aspirin and were randomized to colchicine 1 mg immediately pre-PCI followed by 0.5 mg 24 hours later vs. placebo. The primary endpoint of the study was no-reflow (defined as TIMI flow grade less than 3 or TIMI flow grade=3 with TIMI Myocardial Perfusion grade <1) following primary PCI. Secondary endpoints included target-vessel revascularization (TVR), target-lesion revascularization (TLR), heart failure hospitalization, stroke, nonfatal MI and cardiac death at one month and one year. Other secondary outcomes included ST segment elevation resolution, p-selectin levels and hs-CRP levels. 

Among patients pre-treated with colchicine, there was no difference in the no-reflow phenomenon or resolution of ST elevation as compared to patients treated with placebo (14.4% in both arms). Major adverse cardiac event (MACE) rates between the two groups were also similar at one year (HR 0.87, p=0.54). There was a difference in hs-CRP levels with the colchicine group having lower hs-CRP at 48 hours post-PCI, although the difference was not significant. 

This was a small study performed at a single center, thus, definitive conclusions regarding the utility of colchicine in reducing the no-reflow phenomenon or MACE cannot be drawn. A larger, multi-center randomized trial evaluating MACE in addition to infarct size using cardiac MRI could provide more robust data for the utilization of colchicine pre-PCI. 

All Authors: Alison G. Dupont, MD, FSCAI. 

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