Colchicine reduces risk of some TAVR complications
Giving colchicine to patients before transcatheter aortic valve replacement (TAVR) may reduce the risk of certain conduction disturbances, according to new research published in the Journal of the American Heart Association.[1]
“Despite its safety, TAVR has many possible complications, including new‐onset or worsening conduction disturbances and prosthetic valve mechanical complications, stenosis or thrombosis,” wrote first author Kerollos Abdelsayed, MD, a clinical researcher with the Minneapolis Heart Institute Foundation, and colleagues. “Conduction disturbances like heart block (HB) are frequent after TAVR, especially atrioventricular and left bundle‐branch block (LBBB). The proximity of the aortic valve to the bundle of His and the atrioventricular node exposes the cardiac conduction system to perioperative mechanical trauma and compression, inducing inflammation and edema. Although most common intraoperative, or within the first 24 to 48 hours postoperative, onset might be delayed for up to 30 days postoperative and even later in some studies.”
Colchicine, meanwhile, has been used by clinicians to treat gout for many years now. It was approved by the U.S. Food and Drug Administration (FDA) to treat cardiovascular disease in 2023, and researchers have been working to learn as much as possible about how the drug can potentially improve care for heart patients.
Abdelsayed et al. reviewed data from more than 52,000 real-world patients who underwent TAVR from 2013 to 2024 at one of 52 different facilities. While 705 patients received colchicine prior to treatment, the remaining patients did not. For the colchicine group, the mean ages was 77.5 years old, and 62% of patients were male. For the other group, meanwhile, the mean age was 78 years old and 52% of patients were male. In addition, patients in the colchicine group had a higher mean C-reactive protein and were more likely to present with gout, inflammatory polyarthropathies, hypertension, ischemic heart disease, heart failure or diabetes.
The group used propensity score matching to focus on 702 patients treated with colchicine and another 702 patients who were not treated with colchicine. Overall, 34.3% of patients from the colchicine group and 39.6% of patients from the noncolchicine group experienced atrioventricular block/LBBB within one month. This was viewed as a statistically significant difference. After six months, that difference was gone and there was no longer a difference in atrioventricular block/LBBB rates.
Also, 41.5% of patients from the colchicine group and 46.7% of patients from the noncolchicine group experienced HB after one month. Again, the difference was less significant after the full six months.
Rates of permanent pacemaker implantation, temporary cardiac pacing, high‐grade atrioventricular block/LBBB, cardiac‐related hemodynamic instability (CRHI) and mortality were not significantly different between the two groups after one month or six months.
“Results did not change when patients with any form of conduction disturbance were excluded at baseline, indicating persistent potential benefits on new‐onset conduction disturbances, which was also significantly lower before PSM,” the authors wrote. “Moreover, upon excluding the factors that potentiate colchicine effects at baseline, all results became insignificant supporting a possible dose–response relationship with the drug. Importantly, when colchicine was replaced with allopurinol, a drug commonly used for gout patients who are also frequently prescribed colchicine (>50% in this study), all results became insignificant or even worse in the treatment group potentially reflecting the higher baseline inflammation in patients with gout who needed maintenance treatment, which reinforces the protective association seen with colchicine.”
The group also emphasized that the similar CRHI and mortality rates between groups aligned with other recent research, supporting the idea that colchicine “may have limited efficacy in addressing acute cardiovascular emergencies.”
The group concluded by calling for more research into the potential impact of treating TAVR patients with colchicine prior to treatment.
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.