The Effect of Trimetazidine on C-Reactive Protein, Cytokines and Adhesion Molecules in the Course of Acute Myocardial Infarction

The aim of this randomised, double-blind, placebo controlled, parallel group study was to assess the effect of trimetazidine (TMZ), a potent antiischaemic drug, on plasma C-reactive protein (C-RP), cytokine and adhesion molecule levels. The study population consists of 18 patients (16 males, 2 females, average age 56.45 ± 10.97 years) with acute myocardial infarction admitted within 6 hours after onset of symptoms and treated with streptokinase. Blood samples were taken at 3-hour intervals during the time of treatment. All patients were randomised blindly using a centralised randomisation process, between trimetazidine (40mg bolus iv. then 60mg per day for 48 hours intravenously in glucose infusion) or placebo group. Plasma C-RP level was significantly lower in TMZ group (39.5mg/ml ± 9.7 mg/ml) as compared to placebo (75.7 ± 29.4 mg/ml, p≤0.001) and peaked 28 hours later in TMZ group. Plasma interleukin 6 (IL 6) level showed a sharp peak 9 hours after the onset of the symptoms in TMZ group (116.9 ± 180.2 pg/ml vs. 45.4 ± 37.9 pg/ml) and was increased up to 30 hours after the onset of the symptoms. Plasma interleukin 1 beta (IL 1β) was also higher in TMZ group notably 21 hours after the onset of symptoms (26.4 ± 9.3 pg/ml vs. 16.2 ± 2.4 pg/ml). TMZ group showed lower plasma E-selectin levels. Plasma IL 8, TNF α and ICAM 1 levels were without statistical significant differences. The present study demonstrates a significant reduction of plasma C-reactive protein level in the course of acute myocardial infarction treated with streptokinase and intravenous trimetazidine infusion compared with the group of patients without trimetazidine treatment