{"id":"623b98a4f31e","type":"article","url":"https://hartvaat.nl/2026/02/23/colchicine-en-spironolacton-bij-acuut-myocardinfarct-winratio-analyse-uit-de-cle/","title":"Colchicine en spironolacton bij acuut myocardinfarct: winratio-analyse uit de CLEAR-trial","title_en":"Benefit-risk of colchicine and spironolactone in acute myocardial infarction: a prespecified generalised pairwise comparisons analysis of the CLEAR trial","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["colchicine","colcot-trial"],"journal":"Heart","doi":"http://heart.bmj.com/cgi/content/short/112/6/326?rss=1","source_url":"https://doi.org/http://heart.bmj.com/cgi/content/short/112/6/326?rss=1","authors":["dEntremont","M.-A.","Jolly","S. S.","Alharthi","F.","Shah","B.","Austin","D.","Yi","Q.","Storey","R. F.","Bossard","M.","Cornel","J.","Jaspers Focks","J.","Kedev","S.","Asani","V.","Stankovic","G.","Tsang","M.","Valettas","N.","Tyrwhitt","J.","Betz","J.","Lee","S. F.","Mian","R.","Silvain","J.","Beygui","F.","Czarnecki","A.","Dehghani","P.","Cantor","W.","Lavi","S.","Spratt","J. C.","Belley-Cote","E. P.","Eikelboom","J. W."],"significance":7,"published":"2026-02-23","source_date":"2026-02-23","image":"https://hartvaat.nl/global/img/e8315535d29a.webp","kennis":["https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/","https://hartvaat.nl/kennis/cardiometabool/inflammatie-en-atherosclerose/"],"congress":"","summary_en":"This prespecified CLEAR SYNERGY analysis used generalized pairwise comparisons to assess the benefit-risk of colchicine and spironolactone after acute MI, finding net clinical benefit for colchicine but not for routine spironolactone.","created":"2026-07-03T10:25:07Z","updated":"2026-07-03T13:24:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In een vooraf gespecificeerde analyse van de CLEAR-trial werden colchicine en spironolacton beoordeeld bij acuut myocardinfarct met behulp van de winratio-methode. Deze techniek rangschikt events hiërarchisch en biedt een intuïtievere beoordeling van de balans tussen werkzaamheid en risico.","abstract_original":"Background\n

Composite outcomes in cardiovascular trials often group events of unequal clinical importance, and conventional analyses may obscure treatment trade-offs. Generalised pairwise comparisons (GPC), expressed as a win ratio (WR), allow for hierarchical ranking of events and incorporation of recurrent outcomes, providing a potentially more intuitive assessment of benefit–risk.

\n\nMethods\n

In a prespecified exploratory analysis of the 2x2 factorial, randomised CLEAR (Colchicine and Spironolactone in Patients with Myocardial Infarction) trial (7062 patients within 72 hours of acute myocardial infarction (MI) and percutaneous coronary intervention), we applied both time-to-first and recurrent-event GPC to reassess low-dose colchicine (0.5 mg daily) and spironolactone (25 mg daily) versus placebo. For the colchicine comparison, the hierarchical benefit–risk outcome included all-cause death, strok"}