Effects of Trimetazidine Pretreatment on Endothelial Dysfunction and Myocardial Injury in Unstable Angina Patients Undergoing Percutaneous Coronary Intervention

Abstract

Objectives. Trimetazidine is an anti-ischemic medication licensed for the treatment of angina pectoris. However, the molecular mechanisms underlying its action remain incompletely elucidated. In this study, therefore, we examined the potential beneficial effects of trimetazidine on myocardial injury and endothelial dysfunction in patients with unstable angina in the perioperative period of percutaneous coronary intervention (PCI). Methods. A total of 97 patients with unstable angina were randomly divided into trimetazidine (n = 48) and control (n = 49) groups. All subjects received standard medical therapy. The trimetazidine group additionally received 20 mg trimetazidine three times daily 24 hours before and after PCI. Serum levels of creatine kinase-muscle/brain (CK-MB), cardiac troponin I (cTnI), heart-type fatty acid-binding protein (h-FABP), von Willebrand factor (vWF), and nitric oxide (NO) were measured before and the morning following PCI. Results. In the control group, levels of CK-MB, cTnI, and vWF were significantly elevated (P<0.05) and NO level was decreased after PCI (P<0.05). By contrast, no significant changes in the levels of these proteins were observed in the trimetazidine group after PCI (P>0.05). Moreover, h-FABP levels were not significantly altered after PCI whether in the control or in the trimetazidine group (P>0.05). Finally, a time-dependent increase in the levels of h-FABP from 0 to 6 hours after PCI, followed by a progressive decline, was observed (P<0.05). Conclusions. PCI induces endothelial dysfunction and myocardial damage in patients with unstable angina. Trimetazidine therapy in the perioperative period can reduce this damage.

Efficacy of Trimetazidine in Limiting Periprocedural Myocardial Injury in Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

“…Five studies were then excluded for the following reasons: full-text not available, 20 study results not yet published, 21 patients did not undergo PCI 22 and outcomes not relevant. 23,24 Fifteen trials 10,12,13,15,[25][26][27][28][29][30][31][32][33][34][35] were included in the systematic review and 14 trials in the meta-analysis. Data were not available as mean and standard deviation from one study and hence it was not included in the meta-analysis.…”

“…Data of 3 studies 25,26,29 were sourced from a previous meta-analysis. Study participants were described as stable angina patients in 4 studies, 15,27,32,35 unstable angina in 4 trials, 10,12,25,29 acute coronary syndrome in 2 studies 30,33 and acute myocardial infarction (MI) patients in 2 trials. 13,28 Study participants were also diabetic in 2 trials and had chronic kidney disease patients in 1 study.…”

“…Adequate methods of randomization were only described in 5 studies. 12,13,25,29,33,35 Allocation concealment was not described appropriately in any trial. Blinding of personnel was mentioned in one study, 35 while outcome assessors were blinded in another trial.…”

“…Shao et al, 201912 cTnI, serum creatine kinase, nitric oxide, and von Willebrand factor significantly reduced in TMZ group 24 hours after PCI. Heart-type fatty acid-binding protein levels not significantly different between the 2 groups.TMZ reduces endothelial dysfunction and myocardial damage induced by PCI.Abbreviations: CAD, coronary artery disease; cTnI, cardiac troponin I; LVEF, left ventricular ejection fraction; PCI, percutaneous coronary intervention; PCTA, percutaneous transluminal coronary angioplasty; TIMI, thrombolysis in myocardial infarction; TMZ, trimetazidine.…”

Effect of trimetazidine on incidence of major adverse cardiac events in coronary artery disease patients undergoing percutaneous coronary intervention

“…[ 12 – 14 ] One study showed that trimetazidine treatment could prevent the increase in creatine kinase-MB, cardiac troponin I, and von Willebrand factor and the decrease in nitric oxide induced by PCI, and improve endothelial dysfunction and myocardial injury. [ 15 ] A meta-analysis showed that additional use of trimetazidine significantly improved the left ventricular ejection fraction and reduced elevated cardiac troponin I level and angina attacks during PCI. [ 16 ]…”