Document Detail


Trimetazidine administration minimizes myocardial damage and improves left ventricular function after percutaneous coronary intervention.
MedLine Citation:
PMID:  17503885     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate whether the administration of trimetazidine, a piperazine derivative, to patients before and after percutaneous coronary intervention (PCI) minimizes the PCI-induced myocardial damage and improves left ventricular function 1 and 3 months after the procedure. METHODS: Fifty-two patients hospitalized for acute coronary syndromes (ACS) were included in this study. Patients were randomized into two groups: group A (trimetazidine group; n = 27) and group B (placebo group; n = 25). All patients received conventional antianginal therapy. In addition, group A patients received oral trimetazidine 20 mg every 8 hours, starting 15 days before PCI and continuing for 3 months after the procedure. For each patient, serum troponin I and creatinine kinase (CK)-MB levels were measured before PCI, then at 6, 24, and 48 hours after the procedure; a 2D cardiac echocardiogram was performed before PCI and at 1 and 3 months after the procedure. RESULTS: Twenty-four hours after PCI, troponin I levels were >1 ng/mL in 7 of 27 patients (26%) of group A and 11 of 25 patients (44%) in group B. Fourty-eight hours after revascularization troponin levels remained elevated in 15% of patients in group A and in 32% of patients in group B. Twenty-two percent of patients in group A had CK-MB levels >5 ng/mL, 24 hours after PCI, compared with 40% of patients in group B; four patients of group A had high CK-MB levels prior to PCI procedure. Echocardiographic measurements before revascularization revealed that 11 of 27 patients (40%) in group A had an ejection fraction <50% versus 8 of 24 patients (33%) in group B . The number of patients with an ejection fraction <50% was significantly reduced in group A compared with group B at 1 and 3 months after PCI, i.e. 11% versus 16% (p = 0.046) at 1 month and 4% versus 16% (p = 0.017) at 3 months.A significant improvement in regional wall motion was noted after treatment with trimetazidine compared with placebo. One month after PCI, inferior left ventricular (LV) wall hypokinesia had improved in 4 of 6 trimetazidine recipients and in 4 of 14 placebo recipients (p = 0.014, group A vs group B). After 3 months inferior wall hypokinesia improved in four patients in group A versus six patients in group (p = 0.05). Similarly, anterior LV wall motion improved in 3 of 11 patients in group A and in 1 of 6 patients in group B at 1 month. After 3 months anterior wall hypokinesia had improved in eight patients in group A and in two patients in group B (p = 0.04, group A vs group B). CONCLUSION: The metabolic agent trimetazidine appears to minimize myocardial reperfusion injury during PCI and improves global and regional wall motion at 1 and 3 months after PCI. This study was limited by small patient numbers and further studies are necessary to evaluate exact mechanisms of action and clinical implications of using trimetazidine in conjunction with PCI.
Authors:
Alexandra Labrou; George Giannoglou; Dimitrios Zioutas; Nikolaos Fragakis; George Katsaris; George Louridas
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  American journal of cardiovascular drugs : drugs, devices, and other interventions     Volume:  7     ISSN:  1175-3277     ISO Abbreviation:  Am J Cardiovasc Drugs     Publication Date:  2007  
Date Detail:
Created Date:  2007-05-16     Completed Date:  2007-08-07     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  100967755     Medline TA:  Am J Cardiovasc Drugs     Country:  New Zealand    
Other Details:
Languages:  eng     Pagination:  143-50     Citation Subset:  IM    
Affiliation:
2nd Cardiology Department, G. Papanikolaou General Hospital, Exohi, Thessaloniki 57010, Greece. sotal@the.forthnet.gr
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Administration, Oral
Aged
Angina, Unstable / therapy
Angioplasty, Transluminal, Percutaneous Coronary / adverse effects*
Creatine Kinase, MB Form / blood
Echocardiography
Female
Heart Ventricles / physiopathology
Humans
Hypokinesia
Male
Middle Aged
Myocardial Infarction / therapy
Myocardial Reperfusion Injury / etiology,  prevention & control
Myocardial Revascularization
Premedication
Syndrome
Trimetazidine / pharmacology,  therapeutic use*
Troponin I / blood
Vasodilator Agents / pharmacology,  therapeutic use*
Ventricular Dysfunction, Left / drug therapy*
Chemical
Reg. No./Substance:
0/Troponin I; 0/Vasodilator Agents; 5011-34-7/Trimetazidine; EC 2.7.3.2/Creatine Kinase, MB Form

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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