Trimetazidine Does Not Improve Outcomes Post-Revascualrization

New research presented at the ESC Congress 2020 in Sophia Antipolis, France, suggests that the antianginal agent trimetazidine given after successful percutaneous coronary intervention (PCI) was not effective at reducing adverse outcomes.

Researchers for the ATPCI study, published simultaneously in The Lancet, conducted a randomized, double-blind, placebo-controlled study that included 6,007 patients who had either elective PCI for stable angina or urgent PCI for unstable angina or non-STEMI less than 30 days prior to randomization. Patients were randomly assigned to either oral trimetazidine 35 mg modified-release twice daily (n=2,998) or to a matched placebo (n=3,009). The primary outcome of interest was composite cardiac death; hospital admission for cardiac event; recurrence or persistence of angina requiring an addition/switched/increased does of at least one antianginal drug; or persistent recurrent angina requiring coronary angiography. Median follow-up was 47.5 months.

According to the results, after follow-up, there was no significant difference in the occurrence of the primary study endpoint in the trimetazidine group compared to the placebo group (23.7% vs. 23.3%, respectively; P=0.73). There were also no significant differences in the incidences of components of the composite endpoint between groups. The researchers reported similar results when patients were categorized by either elective or urgent PCI. A total of 1,219 (40.9%) in the treatment arm and 41.1% in the placebo arm showed serious treatment-emergent adverse events. The frequencies of adverse events of interest were also similar between the study cohorts.

“Our results show that the routine use of oral trimetazidine 35 mg twice daily over several years in patients receiving optimal medical therapy, after successful PCI, does not influence the recurrence of angina or the outcome; these findings should be taken into account when considering the place of trimetazidine in clinical practice,” the authors wrote in the abstract. “However, the long-term prescription of this treatment does not appear to be associated with any statistically significant safety concerns in the population studied.”

#ESCCongress https://t.co/qJR8KeXNS9

— Silvia Castelletti (@SilCastelletti) September 1, 2020

💡 The routine use of #trimetazidine 35 mg twice daily over several years in patients receiving optimal medical therapy, after successful PCI, does not influence the recurrence of angina or the outcome… Was anyone still using it?#ESCCongress @TheLancet https://t.co/9HqPYhPryC pic.twitter.com/ITBPhsh37B

— Fernando de la Guía (@Cardio_delaGuia) August 31, 2020

ATPCI:
6000 pats w/ elective PCI or PCI for UAP/NSTEMI within 30 days were randomized to
– trimetazidine 35 mg 2x/d
– placebo

No difference in the 1° combined endpoint (CV death, hospitalization, angina) or any endpoint alone.#ESCCongress @TheLancet https://t.co/9qLT919Zk8 pic.twitter.com/iDh4fmQSH1

— Konstantin Krychtiuk (@krychtiukmd) August 31, 2020