Efficacy of trimetazidine in patients with recurrent angina: a subgroup analysis of the Trimpol II study

SUMMARY

Objectives: The revascularization procedures become more and more popular to treat coronary artery disease, in many countries. Some patients are free of angina after revascularization, without any documented re-stenosis present with recurrent angina symptoms after a period of time. The aim of this work was to assess the efficacy of trimetazidine in the subpopulation of patients with a history of PTCA or CABG, who were included in the TRIMPOL II study.

Methodology: A subgroup of 94 patients was retrospectively analysed from the Trimpol II study, a multicentre, double-blind randomised placebo-controlled trial in 426 patients with stable effort angina. These patients have a history of revascularization for coronary artery disease, and they are still symptomatic after 6 months despite a treatment with metoprolol (50 mg twice daily). They were randomly allocated to receive either trimetazidine (20 mg 3 times daily) or placebo for 12 weeks, on top of the β-blocker. Exercise test parameters, clinical efficacy and safety were assessed. Results were analysed using the Student test, the Mann–Whitney test or the Shapiro–Wilk test.

Results: Compared to placebo, the 12-week treatment with trimetazidine significantly improved: time to 1 mm ST segment depression (385.1 s ± 144.6 s versus 465.0 s ± 143.8 s [p < 0.01]); exercise test duration (466.9 s ± 144.8 s versus 524.4 s ± 131.5 s [p = 0.048]), total workload (9.0 m.e. ± 2.4 m.e versus 10.1 m.e. ± 2.4 m.e [p = 0.035]) as well as time to onset of angina (433.6 s ± 164 s versus 508.1 s ± 132.4 s [p = 0.031]). Weekly number of angina attacks and nitrate consumption were significantly reduced in the trimetazidine group when compared to placebo. Three mild gastro-intestinal side-effects were reported in the trimetazidine group.

Conclusion: These results show that trimetazidine provides anti-anginal efficacy in post-revascularized patients with recurrent angina despite a monotherapy with metoprolol. The treatment was well accepted.

Key words: :

• Recurrent angina
• Revascularization procedures
• Trimetazidine