Objective: To evaluate the effect of pre-procedural acute oral administration of trimetazidine (TMZ) on percutaneous coronary intervention (PCI)-induced myocardial injury. Design: Single-centre, prospective, randomised evaluation study. Setting: Patients with stable angina pectoris and single-vessel disease undergoing PCI. Patients: 582 patients were prospectively randomised. Patients who underwent more than one inflation during PCI were excluded, resulting in 266 patients randomly assigned to 2 groups. Interventions: Patients were randomly assigned to receive or not an acute loading dose of 60 mg of TMZ prior to intervention. Main outcome: The frequency and the increase in the level of cardiac troponin Ic (cTnI) after successful PCI. cTnI levels were measured before and 6, 12, 18 and 24 h after PCI. Results: 136 patients were assigned to the TMZ group and 130 to the control group. Although no statistically significant difference was observed in the frequency of cTnI increase between the two groups, post-procedural cTnI levels were significantly reduced in the TMZ group at all time points (6 h: mean (SD) 4.2 (0.8) vs 1.7 (0.2), p,0.001; 12 h: 5.5 (1.5) vs 2.3 (0.4), p,0.001; 18 h: 9 (2.3) vs 3 (0.5), p,0.001; and 24 h: 3.2 (1.2) vs 1 (0.5), p,0.001). Moreover, the total amount of cTnI released after PCI, as assessed by the area under the curve of serial measurement, was significantly reduced in the TMZ group (p,0.05). Conclusion: Pre-procedural acute oral TMZ administration significantly reduces PCI-induced myocardial infarction.A symptomatic minor post-procedural myocardial necrosis does have an important prognostic signification after percutaneous coronary intervention (PCI). The magnitude of increase in the level of cardiac troponin Ic (cTnI) directly correlates with irreversible myocardial injury assessed by cardiovascular MRI. 1 2 Trimetazidine (TMZ; 1-[2,3,4-trimethoxybenzyl] piperazine) is a cellular anti-ischaemic agent that selectively inhibits the activity of the final enzyme of the fatty acid oxidation pathway, 3-ketoacylcoenzyme A thiolase. Administration of this drug leads to a switch in preference of the energy substrate, resulting in partial inhibition of fatty acid oxidation and increased glucose oxidation. Clinical studies have shown that TMZ has cardioprotective effects in the setting of myocardial ischaemia including acute myocardial infarction.3-8 However, although Kober et al 9 have demonstrated that TMZ reduces preprocedural myocardial cell ischaemia as assessed by the duration and amplitude of ST elevation during PCI, whether its cytoprotective effects translate into a reduction of myocardial necrosis is unknown. The aim of this study was to evaluate the protective effect of an acute oral loading dose of TMZ (60 mg) on post-procedural myocardial infarction as assessed by the frequency and level of cTnI release.
METHODS
Patient population and study protocolA single-centre, prospective, randomised evaluation study was undertaken after approval by the local research ethics committee. The stud...