Trimetazidine Limits the Effects of Myocardial Ischaemia During Percutaneous Coronary Angioplasty

Abstract

This open-label, randomised, controlled study is aimed at assessing the effect of pre-treatment with the metabolic agent trimetazidine on the degree of ischaemia during percutaneous transluminal coronary angioplasty (PTCA). Overall 44 patients with one-vessel coronary artery stenosis (> 70%) in the medial part of the left anterior descending artery were included. One group (n = 22) was pre-treated with oral trimetazidine. The other group (n = 22) was the control. All patients (n = 44) were administered aspirin and conventional treatment. All patients underwent PTCA; stents were implanted in 11 trimetazidine patients and in seven control patients. The mean ST-segment elevation during all balloon inflations was significantly lower in the trimetazidine group than in the control group (-1.66 +/- 1.50 mm vs. 3.29 +/- 1.59 mm, p = 0.001). Maximal ST-segment elevations and mean ST elevation values during sequential balloon inflations were also significantly lower with trimetazidine (p = 0.018). The mean amplitude of the T-wave alterations during all balloon inflations was significantly lower with trimetazidine (3.09 +/- 2.39 mm vs. 6.83 +/- 4.31 mm; p = 0.001). Similarly, the maximal amplitude of the T-wave alterations was 4.50 +/- 2.90 mm with trimetazidine vs. 9.25 +/- 4.97 mm in control patients (p = 0.0005). Angina and rhythm disturbances were more frequent in the control group. Time from balloon inflation to onset of angina was 50 +/- 26.2 s with trimetazidine vs. 32 +/- 15.0 s, for control group (p = 0.03). The time to pain relief after deflation was 19.3 +/- 11.4 s with trimetazidine vs. 28.2 +/- 16.8 s (p = 0.001). Trimetazidine administered a few days before PTCA appears to be a cardioprotective agent for the prevention of myocardial ischaemia.

The Role of Trimetazidine After Acute Myocardial Infarction

“…The maximum and mean values of ST elevation during subsequent inflations were also significantly (p=0.018) lower in the TMZ group. Changes in T-wave amplitude during each balloon inflation were also significantly lower (p=0.001), and angina attacks and arrhythmias were less frequently observed in this group than in the control group [41]. Another study analysing the effect of TMZ on the contractile function of the left ventricle and on heart rate variation in patients undergoing PTCA revealed a reduction in sympathetic activity (p<0.001), increased vagus nerve activation (p<0.05) and improved contractile function of the left ventricle (p<0.001) [42].…”

“…The authors observed that mean ST elevation during inflation was significantly lower in the TMZ group than in the control group (1.66±1.50 vs. 1.59±1.59 mm, p=0.001, respectively). It was also noted that mean T-wave amplitude during each balloon inflation was significantly lower in the TMZ group than in the control group (3.09±2.39 vs. 6.83±4.31 mm, p=0.001) [41]. The authors also measured the time from balloon inflation to the onset of angina symptoms.…”

“…Intravenous TMZ (40 mg in a bolus, then 60 mg iv/day for 48 h) was associated with more frequent and more rapid normalisation of ST segment after successful reperfusion [40]. In another study [41], the effect of TMZ on myocardial ischaemia caused by balloon inflation during PTCA was analysed. ST elevation during balloon inflation was significantly (p=0.001) lower in the TMZ group than in the control group.…”

Metabolic Myocardial Cytoprotectors in Therapy of Stable Ischemic Heart Disease: Evidence Of effectiveness and Use Recommendations

“…К этому выводу пришли многие исследовате-ли, изучавшие эффекты триметазидина у больных ИБС, которым выполнялись ЧКВ и КШ. Например, в работе Polonski et al [32] на относительно небольшой группе больных было показано, что назначение триметазидина в дозе 20 мг 3 р/сут не менее чем за 4 дня до ЧКВ приво-дило к достоверному уменьшению степени элевации сегмента ST во время выполнения процедуры, а также к достоверному уменьшению времени от раздувания бал-лона в коронарной артерии до возникновения ангиноз-ной боли и времени от сдувания баллона до исчезнове-ния боли (рис. 20).…”

Antiischemic Metabolic Modulator Trimetazidine in Treatment of Coronary Heart Disease

“…В естественных условиях было показано, что TACT [18] VASCO [20] ТМЗ может быть применен для кардиопротекции у пациентов, подвергающихся коронарной реваску-ляризации с помощью ЧКВ и АКШ [39,40], при не стабильной стенокардии [41]. Тем не менее, следует признать, что данные, основанные на жестких конеч-ных точках (показатели смертности), до сих пор отсутствуют.…”