Acute coronary syndrome (ACS) as the acute setting of coronary chronic syndrome has been widely known to have high mortality rates. ST segment elevation of myocardial infarction (STEMI) is one category of ACS which occurs when major coronary arteries are fully blocked acutely and diminish coronary flow leading to myocardial injury and necrosis. Epidemiology data showed that global prevalence varied from 3.8% in patients whose age to 9.5%. The national heart survey of Indonesia also revealed the rising trends of STEMI from 0.63% in 2013 to 1.5% in 2018. STEMI is associated with high mortality despite advanced system and management such as primary percutaneous coronary intervention (PCI). Colchisine is derived from Colchicum autumnale plant and known for remedies for a long time since 1500 BC. The remedy effect is due to combination anti-inflammatory actions. Key actions include decrease neutrophile L-selectin expression on endothelial cell and interfere the interaction of neutrophile-platelet which is leading to atherothrombosis. The idea to use colchisine in STEMI patients to reduce mortality rate is presumed through this mechanism. To date, colchisine already known to reduce anti-inflammatory markers in ACS. Colchisine is widely known to be safe and effective as anti-inflammatory drug. Numerous studies had investigated the effect of colchisine in various setting of coronary artery disease. Unfortunately, various results had made it unclear. Meanwhile, the mechanism of colchisine in acute and chronic coronary syndrome need to be explored comprehensively. The evidence of clinical studies for the beneficial use of colchisine in ACS especially in STEMI is still insufficient. The ongoing studies worth to be waited for the supporting clinical evidence for the use of colchisine in acute coronary syndrome.