Can we improve the management of angina patients after percutaneous coronary intervention? Beneficial effects of adding trimetazidine MR therapy after.

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Presentation transcript:

Can we improve the management of angina patients after percutaneous coronary intervention? Beneficial effects of adding trimetazidine MR therapy after PCI in multivessel coronary heart disease patients with diabetes mellitus XU X et al. Clin Drug Investig (2014) 34:251–258 PCI: percutaneous coronary intervention

Treating angina by exclusively targeting coronary obstruction is insufficient Boden et al. (COURAGE Study). N Engl J Med. 2007;356:

Beneficial effects of trimetazidine therapy in CHD patients after PCI Methods  700 coronary heart disease (CHD) patients with diabetes mellitus (DM) who were aged  65 years and undergoing coronary angiography were randomized. Half of them received trimetazidine 20 mg three times daily after stent implantation as an addition to conventional CHD treatment. The other half received conventional treatment alone (approx. 70% of patients were taking  -blockers).  Primary end point: Incidence of recurrent angina pectoris measures of various echocardiographic parameters. XU X et al. Clin Drug Investig (2014) 34:251–258

Results Compared with the control group, trimetazidine significantly reduced recurrent angina pectoris (P=0.010) and silent myocardial ischemia (P=0.009). Beneficial effects of trimetazidine therapy in CHD patients after PCI XU X et al. Clin Drug Investig (2014) 34:251–258

Results Left ventricular function and left ventricular structure were both relatively stable in trimetazidine-treated patients after 2 years of follow-up, while they deteriorated in the control group with a significant difference between groups (all P<0.01). Beneficial effects of trimetazidine therapy in CHD patients after PCI XU X et al. Clin Drug Investig (2014) 34:251–258

Results Independent predictors of recurrent angina pectoris in the 2 years following PCI included three-vessel disease, current smoking, BMI, and history of hypertension and hypercholesterolemia, while trimetazidine treatment had a beneficial effect. Beneficial effects of trimetazidine therapy in CHD patients after PCI Trimetazidine: a predictor of protection XU X et al. Clin Drug Investig (2014) 34:251–258

Beneficial effects of trimetazidine therapy in CHD patients after PCI Discussion XU X et al. Clin Drug Investig (2014) 34:251–258

Conclusion About one-third of patients still have angina after myocardial revascularization. Trimetazidine effectively reduces recurrent angina and preserves left ventricular function in patients with multivessel CHD and DM. These benefits could be linked to the mode of action of trimetazidine MR. By directly providing a 33% increase in the energy supplied to the cardiac cells, trimetazidine MR effectively reduces angina and provides unique cardioprotective benefits.