Effect of trimetazidine on recurrent angina pectoris and left ventricular structure in elderly multivessel coronary heart disease patients with diabetes mellitus after drug-eluting stent implantation: a single-centre, prospective, randomized, double-blind study at 2-year follow-up.
OBJECTIVE
Trimetazidine has been shown to improve angina pectoris and left ventricular (LV) function in diabetic patients with ischaemic cardiomyopathy. The objective of this study was to evaluate the effects of trimetazidine on recurrent angina pectoris and LV structure after drug-eluting stent (DES) implantation in elderly multivessel coronary heart disease (CHD) patients with diabetes mellitus (DM) and a left ventricular ejection fraction (LVEF) of ≥ 50 %.


METHODS
This was a single-centre, prospective, randomized, double-blind evaluation study. Between January 2010 and September 2010, 700 CHD patients with DM who were aged ≥ 65 years and undergoing coronary angiography at An Zhen Hospital (Beijing, China) were recruited and prospectively randomized to receive trimetazidine (20 mg three times daily) or placebo after DES implantation as an addition to conventional CHD treatment. The primary end points were the incidence of recurrent angina pectoris and measures of various echocardiographic parameters, which included LVEF.


RESULTS
At 2-year follow-up, patients in the trimetazidine group (n = 255) showed significant improvements in the incidence (P = 0.024) and severity of angina pectoris, compared with the control group, as well as silent myocardial ischaemia (P = 0.009) and angina pectoris-free survival (P = 0.011). LV function and structure in trimetazidine-treated patients were relatively stable at 2-year follow-up, while they deteriorated in the control group (n = 255) with a significant difference between groups (all P < 0.01). The E peak to A peak (E/A) ratio in trimetazidine-treated patients and in the control group decreased after 2 years; the E/A ratio in trimetazidine-treated patients was slightly better than that in the control group, without a significant difference (P = 0.170). There was no significant difference in event-free survival for the composite end point including death, myocardial infarction, cerebrovascular accident (P = 0.422) and subsequent revascularization (P = 0.073).


CONCLUSIONS
Adjunctive therapy with trimetazidine after DES implantation can have a beneficial effect on recurrent angina pectoris as well as LV function and structure in elderly multivessel CHD patients with DM.
Department of Cardiology, Beijing An Zhen Hospital, Capital Medical University and Beijing Institute of Heart Lung and Blood Vessel Disease, Anzhenli Avenue, Chao Yang District, Beijing, 100029, China.
Xiaohan
X
Xu
Weijun
W
Zhang
Yujie
Y
Zhou
Yingxin
Y
Zhao
Yuyang
Y
Liu
Dongmei
D
Shi
Zhiming
Z
Zhou
Hanying
H
Ma
Zhijian
Z
Wang
Miao
M
Yu
Qian
Q
Ma
Fei
F
Gao
Hua
H
Shen
Jianwei
J
Zhang
D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000188:drug therapy* / Q000517:prevention & control*; D003327:Coronary Disease / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D048909:Diabetes Complications / Q000188:drug therapy*; D004311:Double-Blind Method; D054855:Drug-Eluting Stents; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D055502:Secondary Prevention; D016896:Treatment Outcome; D014292:Trimetazidine / Q000494:pharmacology* / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000494:pharmacology / Q000627:therapeutic use; D016277:Ventricular Function, Left / Q000187:drug effects*
D014665:Vasodilator Agents; D014292:Trimetazidine