Efficacy and safety of trimetazidine after percutaneous coronary intervention (ATPCI): a randomised, double-blind, placebo-controlled trial

Ferrari, Roberto; Ford, Ian; Fox, Kim; Challeton, Jean Pascal; Correges, Anne; Tendera, Michał; Widimský, Petr; Danchin, Nicolás

doi:10.1016/s0140-6736(20)31790-6

Cited by 57 publications

(28 citation statements)

References 18 publications

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“…In addition, this trail also showed there were no statistically significant differences in thrombocutopenia, agranulocytosis, hepatic disorders, etc. between treatment groups (Ferrari et al, 2020).Therefore, trimetazidine is relatively safe even in long-term prescription.…”

Section: Adverse Effectsmentioning

confidence: 96%

Trimetazidine in Heart Failure

et al. 2021

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Heart failure is a systemic syndrome caused by multiple pathological factors. Current treatments do not have satisfactory outcomes. Several basic studies have revealed the protective effect of trimetazidine on the heart, not only by metabolism modulation but also by relieving myocardial apoptosis, fibrosis, autophagy, and inflammation. Clinical studies have consistently indicated that trimetazidine acts as an adjunct to conventional treatments and improves the symptoms of heart failure. This review summarizes the basic pathological changes in the myocardium, with an emphasis on the alteration of cardiac metabolism in the development of heart failure. The clinical application of trimetazidine in heart failure and the mechanism of its protective effects on the myocardium are carefully discussed, as well as its main adverse effects. The intention of this review is to highlight this treatment as an effective alternative against heart failure and provide additional perspectives for future studies.

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Section: Adverse Effectsmentioning

confidence: 96%

Trimetazidine in Heart Failure

et al. 2021

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“…TMZ treatment signi cantly activates AMPK and ERK signaling pathway, and inhibits MMP-2 and MMP-9 expression, which leads to a reduction of oxidative stress in ischemia-reperfusion hearts [5,21]. All of the above mechanisms may contribute to reducing the infarction size for STEMI Some previous researches show no signi cant improvement of TMZ on the prognosis of angina pectoris after recent successful PCI [24]. However, a meta-analysis has reported that early TMZ therapy had overall bene ts upon total MACEs in patients with AMI [12].…”

Section: Discussionmentioning

confidence: 99%

Effect of early Trimetazidine on infarct size in ST-segment-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

Qian¹,

Zhang²,

A³

et al. 2021

Preprint

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Purpose: Trimetazidine, a metabolic agent with anti-ischemic effects, was reported to reduce reperfusion injury in animal models. In this randomized double-blind placebo-controlled trial, we investigated the effects of trimetazidine on reducing infarction size in patients undergoing revascularization for ST-segment elevation myocardial infarction (STEMI). Methods: Patients with STEMI randomly received trimetazidine (n=87) or placebo (n= 86) in a double-blind manner before primary percutaneous coronary intervention (PCI), and study treatment was maintained for 12 months after the procedure. The primary endpoint was infarction size measured by cardiac magnetic resonance (CMR) after primary PCI. Results: The clinical characteristics of patients (90% male, mean age 57±12 years) in both groups were well-matched on the baseline. Compared with patients in control group, the percentage and weight of infarction size of patients in trimetazidine group were both significantly lower (22.1±11.8% [n =74] vs. 26.9±11.9% [n=74], p=0.010; 28±18g [n =74] vs. 35±19g [n=74], p=0.022), the myocardial microvascular obstruction (MVO) rate measured by CMR was lower in trimetazidine group (29.7% [22/7] vs. 52.7% [39/74], p=0.007), while myocardial salvage index (MSI) was significantly higher in trimetazidine group (48±20% vs. 39±27%, p=0.008). The incidence of readmission due to aggravated heart failure in trimetazidine group was lower than that in the control group without significance (8.0% vs 14.0%, p=0.234). Conclusions: Our study provides suggests that trimetazidine initiated prior to primary PCI, improves myocardial infarct size, MVO and MSI, possibly by reducing reperfusion injury.

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“…Por ello, la ATC ha demostrado ser una prueba diagnóstica anatómica capaz de tener un impacto clínico en el manejo de pacientes con SCC, antianginoso al mejorar los síntomas; no obstante, su beneficio en la reducción de complicaciones cardiovasculares es discutible (6) . Como manejo de segunda línea están los nitratos, ivabradina, ranolazina, nicorandil (27)(28)(29) o la trimetazidina; sin embargo, esta última utilizada a una dosis de 35 mg dos veces al día, posterior a una ICP exitosa, no logró influir en la recurrencia de angina ni en el desenlace primario (muerte, hospitalización por causa cardiaca) (30) .…”

Section: Diagnósticounclassified

¿Debo tratar un síndrome coronario crónico de alto riesgo invasivamente desde el inicio? No, en la mayoría de casos

Rueda¹,

Olivares²,

Perez³

et al. 2020

APCyCCV

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La definición de síndrome coronario crónico de alto riesgo varía según la prueba no invasiva empleada para evidenciar isquemia, lo que se consigue a través de un aumento del trabajo miocárdico y la demanda de oxígeno, generados con el uso de fármacos o el ejercicio. El abordaje inicial nos sumerge en la discusión de contextualizar en qué casos priorizar la terapia médica óptima inicial, frente al manejo invasivo inicial con el objetivo de lograr la revascularización miocárdica. Este aspecto central será desarrollado en esta revisión, tomando en cuenta diversos estudios realizados hasta la fecha, en los que el manejo invasivo inicial no ha demostrado ser superior a la terapia médica óptima inicial en resultados clínicos relevantes como muerte o eventos adversos cardiovasculares mayores.

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Efficacy and safety of trimetazidine after percutaneous coronary intervention (ATPCI): a randomised, double-blind, placebo-controlled trial

Abstract: The efficacy and safety of trimetazidine in patients having been treated by percutaneous coronary intervention (ATPCI): Results of a randomised double-blind placebo-controlled trial.

Cited by 57 publications

References 18 publications

Trimetazidine in Heart Failure

Trimetazidine in Heart Failure

Effect of early Trimetazidine on infarct size in ST-segment-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

¿Debo tratar un síndrome coronario crónico de alto riesgo invasivamente desde el inicio? No, en la mayoría de casos

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