P399Colchicine for prevention of atrial fibrillation after open-heart surgery: a systematic review and meta-analysis

Abstract

Background: Post-operative atrial fibrillation (POAF) is the most frequent complication after open-heart surgery. It is associated with increased morbidity and mortality, longer hospital stays, and increased healthcare costs. Prophylactic administration of colchicine may reduce the occurrence of POAF. Method(s): We searched three different databases (PubMed, ClinicalTrials.gov and CENTRAL) to identify randomized controlled trials (RCTs) that (1) compared prophylactic use of colchicine to placebo, or usual care, in patients without a history of atrial fibrillation who underwent elective open-heart surgery and (2) reported POAF-incidence. Trials focused on occurrence of atrial fibrillation after percutaneous interventions or colchicine treatment for non-prophylactic indications were excluded. A random-effects model was used to pool data for POAF-incidence, drug-related adverse effects, major adverse events and hospital length-of-stay. Result(s): A total of five RCTs (1,412 patients) were included. Colchicine treatment reduced POAF-events by 30% versus placebo or usual care (18% vs. 27%, risk ratio (RR) 0.69, 95% confidence interval (CI) 0.57 to 0.84, p=0.0002). Adverse drugrelated effects increased with colchicine (21% vs. 8.2%, RR 2.52, 95% CI 1.62 to 3.93, p<0.0001). However, major adverse events were unchanged (3.2% vs 3.2%, RR 0.96, 95% CI 0.48 to 1.95, p=0.92). Length-of-stay decreased by 1.2 days with colchicine (95% CI-1.89 to-0.44, p=0.002). Conclusion(s): Colchicine showed superior clinical efficacy compared with usual care for prevention of atrial fibrillation after cardiac surgery. In addition, colchicine treatment was associated with shorter hospital stays. These benefits may outweigh the increased risk of adverse drug-related effects.