Giannopoulos et al recently published their work in the AJC , which is of great clinical interest. The investigators showed a significant reduction in myocardial injury (as measured by serum troponin) with the perioperative use of colchicine in patients with stable coronary artery disease undergoing coronary bypass grafting. We especially wonder whether the authors investigated the incidence of early postoperative atrial fibrillation (POAF) in their study. It is an important and easily accountable measure based on their study design. Previous 2 large randomized controlled trials (COPPS and COPPS-2) have demonstrated contrasting results on the efficacy of colchicine in prevention of POAF in patients undergoing cardiothoracic surgery. This leaves us with a question of whether colchicine may reliably prevent POAF in patients undergoing cardiac surgery. One may however speculate the reason for the observed differences in the findings of the previous trials. The COPPS-2 trial perhaps failed to show the benefit from colchicine in prevention of POAF because of a very high patient dropout rate (about 20%), mostly resulting from the drug-related gastrointestinal side effects. Colchicine was initiated 48 to 72 hours preoperatively in the COPPS-2 study (in contrast to the COPPS study in which it was initiated postoperatively), and this was postulated as the cause related to its poor tolerance in patients undergoing major cardiac surgery who may be more vulnerable to its associated side effects. Thus until recently, it was believed that postoperative initiation of colchicine (probably on the second or third postoperative day after a major/cardiac surgery) would be rather better than preoperative initiation to improve its compliance and gain its beneficial effects. Notably, in the present study by Giannopoulos et al, colchicine was initiated 48 hours preoperatively similar to the COPPS-2 study, and yet the compliance rate to the medication remained quite good in this study, being comparable to the patient cohort receiving placebo, and was in contrast to what had been previously observed in the COPPS-2 study. This makes us wonder if other factors also play an important role in the improvement of drug compliance and efficacy. One likely clinical factor is that all patients in the present study were stable patients with coronary artery disease undergoing coronary artery bypass grafting, which is in contrast to the COPPS-2 study in which a myriad of patients undergoing different types of cardiac surgeries (with the exception of cardiac transplantation) were enrolled. These preliminary findings perhaps reassure us that colchicine initiation may be effectively used preoperatively to achieve its good compliance and beneficial effects in carefully selected patients such as especially the stable patients undergoing lone bypass grafting although it may be challenging to do so in sicker and more vulnerable patients undergoing other forms of cardiac surgeries. Nevertheless, future large randomized controlled studies are required to validate these potentially important clinical considerations. Also, future studies should subanalyze the clinical correlation of colchicine use and postoperative serum cardiac biomarkers (troponin) with respect to type V myocardial infarction and post–cardiac surgery inflammatory syndromes (such as postpericardiotomy syndrome), which would further strengthen our understanding on this subject. Thus, based on the current available evidence, perioperative use of colchicine may be considered reasonable for the prevention of myocardial injury in patients with stable coronary artery disease undergoing coronary bypass grafting, prevention of postpericardiotomy syndrome in patients undergoing any form of cardiac surgery (with exception of cardiac transplantation), and prevention of atrial fibrillation provided the initiation of colchicine is performed postoperatively for this purpose.