[Clinical study of trimetazidine for myocardial protection in acute myocardial infarction].
OBJECTIVE
To assess the effect of trimetazidine as an adjunctive treatment to reperfusion therapy in acute myocardial infarction.


METHODS
Sixty patients with acute myocardial infarction were randomized to receive trimetazidine (a loading dose of 60 mg followed by 20 mg 3 times daily) for 2 weeks (n = 32) or to be controls (n = 28). The loading dose was started early before the reperfusion therapy. Patients received intermittent ST-segment monitoring to assess the resolution of ST-segment deviation one hour after reperfusion therapy. Venous blood samples for measurement of malondialdehyde (MDA) and endothelin (ET-1) were taken immediately on admission and 1, 4, 8, 24 and 48 hours as well as 7 days after reperfusion. In-hospital and 3-months major adverse cardiac events were recorded.


RESULTS
Blinded ST-segment analysis showed that there was a more marked return towards baseline one hour after reperfusion therapy in the trimetazidine group, than in the control group [change (7.14 +/- 3.50) mm vs (3.79 +/- 1.32) mm, P = 0.041]. The measurement of plasma MDA showed that, there was a significantly lower level in the trimetazidine group 4, 8, 24, 48 hours and 7 days after reperfusion (P < 0.05). The level of plasma ET-1 was significantly lower in the trimetazidine group 8 hours and 7 days after reperfusion (P < 0.05). There was no side effect due to trimetazidine. Clinical outcomes were similar between the two groups.


CONCLUSIONS
Trimetazidine is effective for the resolution of ST-segment elevation. The effect of trimetazidine against malondialdehyde and ET-1 formation suggested that it might be the mechanism of the myocardial protection.
Dong
Xiao-dong
XD
Department of Cardiology, People's Hospital of Peking University, Beijing 100730, China.
Hu
Da-yi
DY
Jia
San-qing
SQ
Wang
Lei
L
Yan
Song-biao
SB
D000368:Aged; D019332:Endothelin-1 / Q000097:blood; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008315:Malondialdehyde / Q000097:blood; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy* / Q000628:therapy; D015425:Myocardial Reperfusion / Q000379:methods; D014292:Trimetazidine / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000627:therapeutic use
D019332:Endothelin-1; D014665:Vasodilator Agents; D008315:Malondialdehyde; D014292:Trimetazidine