Improving survival in symptomatic ischemic patients with left ventricular dysfunction Beneficial effects of long-term trimetazidine* therapy Fragasso G.

Slides:



Advertisements
Similar presentations
Reference Anker SD. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med. 2009;361:2436–2448. The FAIR-HF Trial Ferric.
Advertisements

Ranexa™ for Chronic Angina An Unmet Need
La stratificazione del rischio aritmico oltre la frazione di eiezione Milano 17 Aprile 2009 Prof. Luigi Padeletti Heart Failure & Co.
Purpose To determine whether metoprolol controlled/extended release
Cardiology Morning Report: Revascularization in Stable Ischemic Heart Disease Bobby Mathew, MD LSU Internal Medicine, HO-II.
Cyclosporine A reduces infarct size and has no detrimental effect of LV remodeling in STEMI patients Michel Ovize Cardiology Hospital and Inserm U886 Lyon.
Can we prevent stent restenosis after coronary stent implantation
Efficacy and safety of angiotensin receptor blockers: a meta-analysis of randomized trials Elgendy IY et al. Am J Hypertens. 2014; doi:10,1093/ajh/hpu209.
The INTENSIFY study: practical daily effectiveness and tolerance of ivabradine in chronic systolic heart failure in Germany Zugck C, Martinka P, Stöckl.
Can we prevent myocardial and renal revascularization injury? Preventive effect of trimetazidine MR on myocardial and renal injury in diabetic patients.
How do we further reduce angina in patients already treated with a hemodynamic agent? Benefits of adding a metabolic agent to other antianginal drugs (
SOLVD (Studies of Left Ventricular Dysfunction)
ICD FOR PRIMARY PREVENTION EVIDENCE REVIEW
Canadian Diabetes Association Clinical Practice Guidelines Treatment of Diabetes in People with Heart Failure Chapter 28 Jonathan G. Howlett, John C. MacFadyen.
A Meta Analysis of Risk of Cardiovascular Events in Patients with Metastatic Breast Cancer (MBC) Treated with Anti Vascular Endothelial Growth Factor (VEGF)
COURAGE: Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation Purpose To compare the efficacy of optimal medical therapy (OMT)
CHARM-Alternative: Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity - Alternative Purpose To determine whether the angiotensin.
CHARM-Preserved: Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity - Preserved Purpose To determine whether the angiotensin.
BEAUTI f UL: morBidity-mortality EvAlUaTion of the I f inhibitor ivabradine in patients with coronary disease and left ventricULar dysfunction Purpose.
SIGN CHD In Scotland in the year ending 31 March 2006 over 10,300 patients died from CHD and 5,800 from cerebrovascular disease, with.
European guidelines on the management of stable coronary artery disease Key points & new position for Ivabradine and Trimetazidine ESC 2013 Montalescot.
Impact of Concomitant Tricuspid Annuloplasty on Tricuspid Regurgitation Right Ventricular Function and Pulmonary Artery Hypertension After Degenerative.
Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients Assessment.
The burden Of heart failure
Benefits of adding a energetic agent to  -blockers to achieve optimal reduction of angina. Review of the main studies.
S. HUNT Tenth International Symposium HEART FAILURE & Co. CARDIOLOGY SCIENCE UPDATE FEMALE DOCTORS SPEAKING ON FEMALE DISEASES Milano aprile 2010.
CAST: Cardiac Arrhythmia Suppression Trial Purpose To determine whether therapy with class Ic antiarrhythmics to suppress asymptomatic or mildly symptomatic.
RALES: Randomized Aldactone Evaluation Study Purpose To determine whether the aldosterone antagonist spironolactone reduces mortality in patients with.
S ystolic H eart failure treatment with the I f inhibitor ivabradine T rial Efficacy and safety of ivabradine in patients with severe chronic systolic.
BEST: Beta-blocker Evaluation Survival Trial Purpose To determine whether the β-blocker bucindolol reduces morbidity and mortality in patients with advanced.
CIBIS II Cardiac Insufficiency Bisoprolol Study
Can we protect patients undergoing percutaneous coronary intervention better? Beneficial effects of short- and long-term trimetazidine MR therapy in patients.
COMET: Carvedilol Or Metoprolol European Trial Purpose To compare the effects of carvedilol (a β 1 -, β 2 - and α 1 -receptor blocker) and short-acting.
Could an antianginal metabolic agent have an impact on prognosis in ischemic patients? Beneficial effects of trimetazidine in patients with acute myocardial.
Contemporary Management of Myocardial Ischemia
Bangalore S, et al. β-Blocker use and clinical outcomes in stable outpatients with and without coronary artery disease. JAMA. 2012;308(13): ?
Is the Decision-Making after Failure of CTO Angioplasty Same? Infarct Related CTO or Non- Infarct Related CTO (Continue the Procedure in Other Vessel or.
Can we better protect patients who undergo revascularization? Beneficial effects of short- and long-term trimetazidine MR therapy in patients undergoing.
Perindopril Remodeling in Elderly with Acute Myocardial Infarction PREAMIPREAMI Presented at The European Society of Cardiology Hot Line Session, September.
Candesartan in Heart Failure Presented at European Society of Cardiology 2003 CHARM Trial.
STICH CABG Objective To determine whether surgery plus medical management or medical management alone improve outcomes in CABG patients Study Design 1212.
Prospective Evaluation of EECP in Congestive Heart Failure (PEECH) Trial PEECH Trial Presented at The American College of Cardiology Scientific Sessions.
Many alternatives for treating ischemia and angina: how to choose?
Rosuvastatin 10 mg n=2514 Placebo n= to 4 weeks Randomization 6weeks3 monthly Closing date 20 May 2007 Eligibility Optimal HF treatment instituted.
Can we improve the management of angina patients after percutaneous coronary intervention? Beneficial effects of adding trimetazidine MR therapy after.
COPERNICUS: Carvedilol Prospective Randomized Cumulative Survival trial Purpose To assess the effect of carvedilol, a β 1 -, β 2 - and α 1 -receptor blocker,
Ten Year Outcome of Coronary Artery Bypass Graft Surgery Versus Medical Therapy in Patients with Ischemic Cardiomyopathy Results of the Surgical Treatment.
Left Ventricular Filling Pressure by Doppler Echocardiography in Patients With End-Stage Renal Disease Angela Y-M Wang, Mei Wang, Christopher W-K Lam,
Erectile Dysfunction and Cardiovascular Disease. ED and Cardiovascular Diseases.
Date of download: 7/5/2016 Copyright © The American College of Cardiology. All rights reserved. From: Cardiopoietic Stem Cell Therapy in Heart Failure:
Date of download: 7/8/2016 Copyright © The American College of Cardiology. All rights reserved. From: Tolerability and efficacy of carvedilol in patients.
Radiofrequency Ablation as Initial Therapy in Paroxysmal Atrial Fibrillation Jens Cosedis Nielsen, M.D., D.M.Sc., Arne Johannessen, M.D., D.M.Sc., Pekka.
JOURNAL REVIEW HEART FAILURE MANAGEMENT – BETA BLOCKERS
Revascularization in Patients With Left Ventricular Dysfunction:
Clinical need for determination of vulnerable plaques
Valsartan in Acute Myocardial Infarction Trial Investigators
Cardiac Toxicity on NSABP B-31
The following slides highlight a presentation at the Late-Breaking Clinical Trials session of the American Heart Association Scientific Sessions, November.
The most common cause of death in North America is cardiac death and the most common cause of cardiac death is sudden death from ventricular arrhythmias.
Figure 4 BMI and mortality in patients with heart failure
European Heart Association Journal 2007 April
INOVATE-HF Trial design: Patients with heart failure (HF) were randomized to device implant for vagus nerve stimulation (n = 436) versus optimal medical.
Figure 4 Effects of delaying cardioprotective medications after anthracycline administration Figure 4 | Effects of delaying cardioprotective medications.
Nat. Rev. Cardiol. doi: /nrcardio
Gaurav A. Upadhyay, MD, Jonathan S. Steinberg, MD  Heart Rhythm 
CIBIS II: Cardiac Insufficiency Bisoprolol Study II
TACTICS-HF Trial design: Patients with acute heart failure (reduced or preserved ejection fraction) were randomized to tolvaptan 30 mg at 0, 24, and 48.
Questions and answers about the STICH trial: A different perspective
The FAIR-HF Trial Reference
Presentation transcript:

Improving survival in symptomatic ischemic patients with left ventricular dysfunction Beneficial effects of long-term trimetazidine* therapy Fragasso G et al. Int J Cardiol. In press. Presented at AHA 2012 *Trimetazidine is indicated by the European Medecines Agency (EMA) as add-on therapy for the symptomatic treatment of patients with stable angina pectoris who are inadequately controlled by or intolerant to first-line antianginal therapies.

What do preliminary data say? Gao meta-analysis n=61 Patients with severe ischemic cardiomyopathy El Kady T et al. Am J Cardiovasc Drugs. 2005;5: Di Napoli P et al. J Cardiovasc Pharmacol. 2007;50: Fragasso et al. J Am Coll Cardiol. 2006;48: Iyengar S et al. Am J Cardiovasc Drugs. 2009;9: Gao D et al. Heart. 2011;97(4): Zhang L et al. J Am Coll Cardiol. 2012;59: Zhang meta-analysis A study with a homogeneous and relevantly sized population is needed. METRO Study El-Kady Study n=955 Heart failure patients n=200 Angina patients with ischemic left ventricular dysfunction Di Napoli Study n=353 Angina patients with acute myocardial infarction n=884 Heart failure patients => First data on mortality evaluated as a safety parameter => Complemen- tary results on mortality in a small population => Primary objective was to assess the 6-month survival rate 2011 => First meta- analysis demonstrating mortality results n=number of patients. n=65 Patients with heart failure 2006 Fragasso Study => First results on mortality in a small population Kim J et al. WCC Abstract

A new study designed to evaluate survival International multicenter retrospective cohort study Inclusion criteria: – Ejection fraction ≤ 45% – NYHA Class II-IV – Trimetazidine (TMZ) administered if symptoms persist despite correct titration of standard medical therapy for chronic heart failure (CHF) CHF was of ischemic origin in >80% of patients Mean follow-up: 3 years Propensity score 669 Symptomatic heart failure patients Fragasso G et al. Int J Cardiol. In press.

TMZ improves survival TMZ significantly improves global survival by 11.3% (P=0.015). Global survival Event-free survival Fragasso G et al. Int J Cardiol. In press.

TMZ reduces global and cardiovascular mortality Heart failure patients live longer with TMZ. Fragasso G et al. Int J Cardiol. In press.

TMZ reduces rate of hospitalization for cardiovascular causes Heart failure patients live better with TMZ. Fragasso G et al. Int J Cardiol. In press.

The addition of TMZ to standard medical therapy in patients with CHF significantly reduces total and cardiovascular mortality and improves event-free survival. Therefore, this study confirms in a homogeneous and relevantly sized population that TMZ should be considered as a potential additional medication to standard therapy in CHF patients. These results could be explained by the ability of TMZ to reduce ischemia whatever the causal mechanism, and therefore to protect the heart from subsequent damage. Conclusion: Fragasso G et al. Int J Cardiol. In press.