Trimetazidine after successful PCI not associated with fewer cardiac events

Patients undergoing a successful percutaneous coronary intervention (PCI) for angina and non-ST-segment elevation acute coronary syndromes (NSTE-ACS) have good long-term outcomes using optimal medical therapy. Routine use of trimetazidine did not reduce cardiac events in this patient population in the ATPCI trial [1]. These results, presented at the ESC Congress by Prof. Roberto Ferrari (University of Ferrara, Italy), were simultaneously published in The Lancet [2].

Little evidence is available regarding the prognostic benefits of antianginal drugs, such as trimetazidine, after PCI. Trimetazidine improves energy metabolism of the ischaemic myocardium and might improve outcomes and symptoms of patients who recently had a PCI. The ATPCI study aimed to evaluate the long-term potential benefits and safety of trimetazidine added to standard guideline-recommended medical treatment in in a population of 6,007 patients who had had a recent PCI for stable angina, unstable angina, or non-ST-segment elevation myocardial infarction.

After a median follow-up of 47.5 months, trimetazidine did not improve the primary composite efficacy endpoint of cardiac death, hospital admission for cardiac event, or recurrence or persistence of angina incidence compared with placebo (23.3 vs 23.7%; HR 0.98; P=0.73). Also, no significant differences were observed in the incidence of the components of the primary endpoint between the treatment groups. Similar results were obtained in sub analyses by elective or urgent PCI. Long-term use of trimetazidine was not associated with any safety issues.

The routine use of oral trimetazidine 35 mg twice daily over several years in patients receiving optimal medical therapy after successful angioplasty does not influence the outcome or recurrence of angina. These findings should be taken into account when considering the place of trimetazidine in clinical practice.

 

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   1. Ferrari R. TPCI - Trimetazidine in angina patients with recent successful percutaneous coronary intervention: a randomized, double-blind, placebo-controlled trial. Hot Line 2 session, ESC Congress 2020, 30 Aug.
   2. Ferrari R, et al. Lancet 2020, August 30. DOI: 10.1016/S0140-6736(20)31790-6.

 



Posted on 5 November, 202023 April, 2024