title: Efficacy of trimetazidine in patients with recurrent angina: a subgroup analysis of the TRIMPOL II study.
abstract: OBJECTIVE
  The revascularization procedures become more and more popular to treat coronary artery disease, in many countries. Some patients are free of angina after revascularization, without any documented re-stenosis present with recurrent angina symptoms after a period of time. The aim of this work was to assess the efficacy of trimetazidine in the subpopulation of patients with a history of PTCA or CABG, who were included in the TRIMPOL II study.
  
  
  METHODS
  A subgroup of 94 patients was retrospectively analysed from the TRIMPOL II study, a multicentre, double-blind randomised placebo-controlled trial in 426 patients with stable effort angina. These patients have a history of revascularization for coronary artery disease, and they are still symptomatic after 6 months despite a treatment with metoprolol (50 mg twice daily). They were randomly allocated to receive either trimetazidine (20 mg 3 times daily) or placebo for 12 weeks, on top of the beta-blocker. Exercise test parameters, clinical efficacy and safety were assessed. Results were analysed using the Student test, the Mann-Whitney test or the Shapiro-Wilk test.
  
  
  RESULTS
  Compared to placebo, the 12-week treatment with trimetazidine significantly improved: time to 1 mm ST segment depression (385.1 s +/- 144.6 s versus 465.0 s +/- 143.8 s [p < 0.01]); exercise test duration (466.9 s +/- 144.8 s versus 524.4 s +/- 131.5 s [p = 0.048]), total workload (9.0 m.e. +/- 2.4 m.e versus 10.1 m.e. +/- 2.4 m.e [p = 0.035]) as well as time to onset of angina (433.6 s +/- 164 s versus 508.1 s +/- 132.4 s [p = 0.031]). Weekly number of angina attacks and nitrate consumption were significantly reduced in the trimetazidine group when compared to placebo. Three mild gastro-intestinal side-effects were reported in the trimetazidine group.
  
  
  CONCLUSIONS
  These results show that trimetazidine provides anti-anginal efficacy in post-revascularized patients with recurrent angina despite a monotherapy with metoprolol. The treatment was well accepted.
authors.affiliation: Department of General Cardiology, National Institute of Cardiology, Warsaw, Poland. aninco@yahoo.com
authors.forename: W
authors.initials: W
authors.lastname: Ruzyllo
authors.forename: H
authors.initials: H
authors.lastname: Szwed
authors.forename: Z
authors.initials: Z
authors.lastname: Sadowski
authors.forename: W
authors.initials: W
authors.lastname: Elikowski
authors.forename: H
authors.initials: H
authors.lastname: Grzelak-Szafranska
authors.forename: W
authors.initials: W
authors.lastname: Orszulak
authors.forename: K
authors.initials: K
authors.lastname: Szymczak
authors.forename: M
authors.initials: M
authors.lastname: Winter
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000787:Angina Pectoris / Q000188:drug therapy* / Q000503:physiopathology; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000008:administration & dosage; D008875:Middle Aged; D012008:Recurrence; D014292:Trimetazidine / Q000008:administration & dosage*; D014665:Vasodilator Agents / Q000008:administration & dosage*
chemical_list: D000319:Adrenergic beta-Antagonists; D014665:Vasodilator Agents; D008790:Metoprolol; D014292:Trimetazidine