Trimetazidine as adjunctive therapy for decreasing major adverse cardiac events in coronary artery disease patients undergoing reperfusion strategy: a meta-analysis of randomized controlled trials

Abstract

Abstract Background Trimetazidine as adjunctive therapy in cardioischemic patients has shown improvement in angina and left ventricular ejection fraction. Recent trials have conflicting evidence on its effect on hard clinical outcomes. Purpose The objective of this meta-analysis is to compare the efficacy of trimetazidine versus placebo in reducing cardiac mortality and major adverse cardiac events (MACE) in coronary artery disease patients after reperfusion strategy. Methods A literature search was done using the terms “coronary artery disease” OR “acute myocardial infarction” OR “stable angina pectoris” AND “percutaneous coronary intervention” OR “thrombolysi” OR “reperfusion” AND “trimetazidine” OR “trimetazidine dihydrochloride” AND “randomized controlled trial”. We included trials using trimetazidine versus placebo in coronary artery disease patients who underwent percutaneous coronary intervention or thrombolysis. Two reviewers independently applied eligibility criteria, assessed quality, and extracted data. The primary outcomes were cardiac mortality and combined major adverse cardiac events; secondary outcomes were repeat revascularization, heart failure after reperfusion, stent restenosis, recurrence of angina, and reinfarction. Risk ratios were calculated for pooled data using random effects and fixed effects models. Results This study included five trials involving a total of 26,977 patients. Trimetazidine in comparison to placebo was associated with lower cardiac mortality and combined MACE, but results were not significant. Among secondary outcomes, only stent restenosis was significantly reduced (risk ratio, 0.53; 95% CI, 0.34–0.83; p=0.006). Conclusion Trimetazidine as adjunctive therapy does not reduce cardiac mortality, combined MACE, repeat revascularization, heart failure, recurrence of angina and reinfarction in coronary artery disease patients after reperfusion. However, it does significantly reduce stent restenosis in the said population. Further trials should be conducted with more standard dosing regimens, duration of therapy, and similar severities of ischemic disease. Funding Acknowledgement Type of funding sources: None.