title: Efficacy and Safety of Adjunctive Trimetazidine Therapy for Acute Myocardial Infarction: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Several lines of evidence support the clinical use of trimetazidine as an adjunctive therapy in cardioischemic patients. Therefore, we assessed here the efficacy and safety of adjunctive trimetazidine therapy in acute myocardial infarction (MI) patients by a systematic review and meta-analysis of the current literature.
  
  
  METHODS
  PubMed, the Cochrane Library, and the China National Knowledge Infrastructure databases were searched for clinical studies comparing adjunctive trimetazidine therapy against placebo in adult acute MI patients. Several clinical outcomes [early/short-term all-cause mortality, long-term all-cause mortality, total major adverse cardiac events (MACE), recurrent nonfatal MI, in-hospital adverse events, target vessel revascularization (TVR), and coronary artery bypass graft (CABG)] were analyzed by the intention-to-treat principle. Odds ratios (OR) and their 95% confidence intervals (CI) were derived from the number of outcome events in each study arm to estimate the association between adjuvant trimetazidine administration and the various clinical outcomes. A random-effects model was applied for all meta-analyses.
  
  
  RESULTS
  We found that adjunctive trimetazidine therapy showed a significant effect upon total MACE (OR = 0.33, 95% CI = 0.15-0.74; p = 0.007) but showed no significant effect upon early/short-term all-cause mortality, long-term all-cause mortality, recurrent nonfatal MI, in-hospital adverse events, TVR, or CABG (p > 0.05).
  
  
  CONCLUSIONS
  This is the first meta-analysis to report that adjunctive trimetazidine therapy has a beneficial effect upon total MACE in acute MI patients. Clinical investigators should consider further trials on adjunctive trimetazidine therapy in order to better define its risks and benefits in acute MI patients.
authors.affiliation: Department of Cardiology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
authors.forename: Yongyong
authors.initials: Y
authors.lastname: Li
authors.forename: Dewei
authors.initials: D
authors.lastname: Wang
authors.forename: Chunxiao
authors.initials: C
authors.lastname: Hu
authors.forename: Peng
authors.initials: P
authors.lastname: Zhang
authors.forename: Dongying
authors.initials: D
authors.lastname: Zhang
authors.forename: Shu
authors.initials: S
authors.lastname: Qin
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control; D003131:Combined Modality Therapy; D057194:Intention to Treat Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D014292:Trimetazidine / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D014292:Trimetazidine