title: The effectiveness of preoperative trimetazidine on myocardial preservation in coronary artery bypass graft patients: a systematic review and meta-analysis.
abstract: BACKGROUND
  Coronary artery bypass grafting (CABG) is a key and effective surgical treatment modality for coronary artery disease. Unfortunately, ischemia-reperfusion injury during and after CABG can lead to reversible and irreversible myocardial damage. Trimetazidine [1-(2,3,4-trimethoxybenzyl)piperazine dihydrochloride] is a metabolic anti-ischemic agent with demonstrated cardioprotective effects; however, its effects with respect to myocardial preservation in CABG patients remain unclear.
  
  
  METHODS
  We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to investigate the effectiveness of myocardial preservation of preoperative trimetazidine therapy in CABG patients by assessing the postoperative levels of several blood-based biochemical markers of myocardial injury, including creatine kinase (CK), creatine kinase-muscle and brain (CK-MB), creatine phosphokinase (CPK), troponin T (TnT) and troponin I (TnI). The RCTs were classified into two subgroup analyses by the timing of sample collection (either ≤12 or >12 h after CABG).
  
  
  RESULTS
  Six RCTs were finally included in the meta-analysis. The pooled effect sizes showed significantly lower postoperative levels of CK, CK-MB, TnT and TnI in the trimetazidine-treated CABG patients relative to control CABG patients. However, there were no significant differences in the postoperative CPK levels between trimetazidine-treated CABG patients relative to control CABG patients. In both the ≤12 and >12 h post-CABG subgroup analyses, significant differences in CK, CK-MB, TnT and TnI were detected between the trimetazidine-treated CABG patients relative to control CABG patients.
  
  
  CONCLUSIONS
  Preoperative trimetazidine therapy appears to have a positive effect on myocardial preservation in CABG patients.
authors: Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors: Nan
authors: N
authors: Zhang
authors: Jiayan
authors: J
authors: Lei
authors: Qing
authors: Q
authors: Liu
authors: Wei
authors: W
authors: Huang
authors: Hua
authors: H
authors: Xiao
authors: Han
authors: H
authors: Lei
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D052279:Creatine Kinase, MB Form / Q000378:metabolism; D006801:Humans; D015428:Myocardial Reperfusion Injury / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000209:etiology; D011300:Preoperative Care / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D014292:Trimetazidine / Q000627:therapeutic use*; D014336:Troponin / Q000378:metabolism; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D015415:Biomarkers; D002316:Cardiotonic Agents; D014336:Troponin; D014665:Vasodilator Agents; D052279:Creatine Kinase, MB Form; D014292:Trimetazidine