Effect of trimetazidine on recurrent angina and left ventricular function in elderly multivessel coronary heart disease patients with diabetes mellitus after elective percutaneous coronary interventio

Abstract

Objective: To evaluate the effect of trimetazidine (TMZ) on recurrent angina and left ventricular function in elderly multivessel coronary heart disease (CHD) patients with diabetes mellitus (DM) after elective percutaneous coronary intervention (PCI). Methods: In this single-center, prospective, randomized evaluation study, 400 patients with DM aged 65 and over undergoing coronary angiography were recruited to randomly receive or not TMZ (20 mg three times daily orally) as an addition to the conventional treatment of CHD at admission before angiography. Recurrent angina and echocardiogram were followed at 2 years after PCI. Results: Two hundred and fifty-one patients who successfully underwent elective PCI were finally enrolled, 125 in the TMZ group and 126 in the control group. At 2-year follow up, patients in the TMZ group showed a significant improvement in the proportion of angina patients (40 (31.2%) vs 58 (46.0%), P=0.023) and angina-free survival (P=0.003). The independent predictors of 2-year recurrent angina included no TMZ treatment, current smoking, hypercholesterolemia and BMI. TMZ-treated patients showed a significant greater left ventricular function and smaller left ventricular diastolic and systolic diameters compared with patients in the control group (LVEF: 65.65±3.870% vs 62.34±3.008%; LVEDD: 47.6±4.637 mm vs 50.86±3.597 mm; LVESD: 31.00±4.255 vs 33.06±3.371 mm, all P<0.01). E:A ratio in TMZ-treated patients was better than that in the control group without significant difference (0.849±0.256 vs 0.808±0.313, P=0.464). Although there was a trend towards a decrease in cumulative cardiovascular events in TMZ-treated patients, there was no significant difference in event–free survival for composite major adverse cardiac events including death, MI, TVR and hospitalization for cardiac causes (P=0.163). Conclusion: Adjunctive therapy of TMZ (20 mg tid) after PCI reduces the occurrence of recurrent angina, improve left ventricular function and inhibit left ventricular remodeling in elderly multivessel CHD patients with DM.