title: A randomized double-blind trial of intravenous trimetazidine as adjunctive therapy to primary angioplasty for acute myocardial infarction.
abstract: BACKGROUND
  Despite high patency rates, primary angioplasty for myocardial infarction does not necessarily result in optimal myocardial reperfusion and limitation of infarct size. Experimentally, trimetazidine limits infarct size, decreases platelet aggregation, and reduces leukocyte influx into the infarct zone. To assess trimetazidine as adjunctive therapy to primary angioplasty for acute myocardial infarction a prospective, double-blind, placebo-controlled pilot trial was performed.
  
  
  METHODS
  94 patients with acute myocardial infarction were randomized to receive trimetazidine (40 mg bolus followed by 60 mg/day intravenously for 48 h) (n=44) or placebo (n=50), starting before recanalization of the infarct vessel by primary angioplasty. Patients underwent continuous ST-segment monitoring to assess return of ST-segment deviation to baseline and presence of ST-segment exacerbation at the time of vessel recanalization. Infarct size was measured enzymatically from serial myoglobin measurements. Left ventricular angiography was performed before treatment and repeated at day 14.
  
  
  RESULTS
  Blinded ST segment analysis showed that despite higher initial ST deviation from baseline in the trimetazidine group (355 (32) vs. 278 (29) microV, P=0.07), there was an earlier and more marked return towards baseline within the first 6 h than in the placebo group (P=0.014) (change: 245 (30) vs. 156 (31) microV respectively, P=0.044). There was a trend towards less frequent exacerbation of ST deviation at the time of recanalization in the trimetazidine group (23.3 vs. 42.2%, P=0.11). There was no difference in left ventricular wall motion at day 14, or in enzymatic infarct size. There was no side effect from treatment. Clinical outcomes were similar between groups.
  
  
  CONCLUSIONS
  Trimetazidine was safe and led to earlier resolution of ST-segment elevation in patients treated by primary angioplasty for acute myocardial infarction.
authors.affiliation: Cardiologie, Hôpital Bichat, 46 rue Henri Huchard, 75877 Cedex 18, Paris, France. gabriel.steg@bch.ap-hop-paris.fr
authors.forename: P G
authors.initials: PG
authors.lastname: Steg
authors.forename: G
authors.initials: G
authors.lastname: Grollier
authors.forename: P
authors.initials: P
authors.lastname: Gallay
authors.forename: M
authors.initials: M
authors.lastname: Morice
authors.forename: G J
authors.initials: GJ
authors.lastname: Karrillon
authors.forename: H
authors.initials: H
authors.lastname: Benamer
authors.forename: C
authors.initials: C
authors.lastname: Kempf
authors.forename: T
authors.initials: T
authors.lastname: Laperche
authors.forename: P
authors.initials: P
authors.lastname: Arnaud
authors.forename: P
authors.initials: P
authors.lastname: Sellier
authors.forename: C
authors.initials: C
authors.lastname: Bourguignon
authors.forename: C
authors.initials: C
authors.lastname: Harpey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D017024:Chemotherapy, Adjuvant; D017023:Coronary Angiography; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000628:therapy*; D014292:Trimetazidine / Q000008:administration & dosage / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D014292:Trimetazidine