BACKGROUND: Despite optimal therapy, coronary artery disease (CAD) remains a significant public health concern worldwide. Studies have increasingly recognized the role of inflammation in atherosclerosis. Colchicine, a potent anti-inflammatory drug commonly used to treat gout, and pericarditis is being evaluated in this study for its safety and efficacy in preventing CAD following an acute coronary syndrome (ACS). METHODS: We searched PubMed and Embase for studies up to April 2024 comparing colchicine to standard medical treatment in ACS patients. Primary outcomes included major adverse cardiovascular events (MACE) and recurrent ACS, while secondary outcomes were cardiovascular death, congestive heart failure (CHF), stroke, hospitalizations, and gastrointestinal (GI) side effects. Data were pooled using a random-effects model. RESULTS: We included nine studies with a pooled sample size of 7260 patients. The mean age was 60.1 (±11.8) years, with 19.3 % females and a mean follow-up duration of 8.5 (±6) months. Patients who received colchicine treatment demonstrated a reduced risk of re-hospitalizations (OR 0.52 [0.34-0.81]) but had increased GI effects (OR 2.10 [1.20-3.68]). There was no significant difference in cardiovascular death (OR 1.17 [0.52-2.63]), MACE (OR 0.68 [0.45-1.01]), stroke (OR 0.46 [0.18-1.18]), recurrent ACS (OR 0.55 [0.28-1.09]) and the incidence of CHF (OR 0.90 [0.38-2.12]) between patients treated with colchicine versus standard medical treatment. CONCLUSION: Adding colchicine to standard medical therapy in ACS patients significantly reduced hospitalizations but is associated with increased GI side effects. Further prospective trials are required to validate these findings and determine if early intervention with colchicine treatment improves clinical outcomes in ACS patients.