Impact of Colchicine on Peri-Operative Major Adverse Cardiovascular Events in Patients With Prior Coronary Revascularization: The Peri-OPerative COlchicine to Reduce Negative Events (POPCORN) Trial

Heart disease remains the leading cause of death in Veterans. Inflammation in the arteries of the heart may increase the risk of cardiac death. Patients with heart disease undergoing major surgery are at increased risk of complications after surgery, including heart attack, stroke, and death. The proposed research seeks to better understand the role of inflammation in the damage to the heart and blood vessels after major surgery. This research also seeks to identify the potential beneficial role of a safe medication, colchicine, which has direct effects on inflammatory cells and has been used in the treatment of inflammatory diseases for more than 2000 years, on reducing the rate of complications after surgery. With its quick onset of action and excellent safety profile, colchicine may have the potential to reduce risk of heart injury, stroke, or death after major surgery.

Inclusion Criteria:Men and women with prior coronary revascularization (via PCI or coronary artery bypass graft surgery) referred for intermediate- (>3% cardiovascular risk with general abdominal or intraperitoneal surgery) versus high-risk (>5% cardiovascular risk with suprainguinal surgery, peripheral vascular surgery, thoracic surgery) surgery [2,89].If planned for only a laparoscopic or endovascular approach, at least one component of the Revised Cardiac Risk Index score (history of myocardial infarction, history of congestive heart failure, history of transient ischemic attack or stroke, pre-operative use of insulin, pre-operative creatinine >2 mg/dL) should be present.Exclusion Criteria:Colchicine use within one month or history of colchicine intoleranceInflammatory bowel disease with history of diarrhea as presentation or chronic diarrheaPre-existent progressive neuromuscular diseaseamyotrophic lateral sclerosishereditary muscular disordersmyositisnecrotizing myopathymyasthenia gravislambert-eaton syndromeGlomerular filtration rate <30mL/minute or on dialysisHistory of cirrhosis, chronic active hepatitis or severe hepatic diseaseHistory of myelodysplasia with current evidence of cytopeniaActive infection defined as fever >100.4oF or antibiotic use with white blood cell count greater than the upper limit of normal or lower than the lower limit of normal within 24 hours of randomization (major confounder with increased inflammatory markers)Undergoing immunosuppressive or immunostimulatory chemo or biologic therapyPregnant (as confirmed by urine or serum test), nursing, or planning to become pregnant during study participationParticipating in a competing study or unable to consentAny significant condition or situation that may put the participant at higher risk, confound the study results, or interfere with adherence to study proceduresPatients on strong CYP3A4 and/or P-glycoprotein inhibitors (e.g., ritonavir, clarithromycin, diltiazem, verapamil) at baseline will also be excluded due to potential drug interactionsHowever, if one of these medications are started during the post-operative study period, dose adjustments will be made per drug package insertParticipants will also be instructed not to drink grapefruit juice while on study drug