The effect of trimetazidine added to maximal anti-ischemic therapy in patients with advanced coronary artery disease

Background: The purpose of the study was to assess the effect of trimetazidine administered for 20 days in 56 patients with ischemic heart disease treated with maximal tolerated doses of anti-ischemic drugs who were not candidates for percutaneous or surgical revascularization. Methods: The efficacy of trimetazidine was evaluated by comparing exercise testing parameters before and after treatment, combined with the patient response to a questionnaire administered at baseline and following the treatment. We evaluated the duration of exercise, workload, double product, time to the occurrence of ischemic changes in ECG, the number of leads with diagnostic ST segment depression, and the magnitude of ST segment depression. Results: After 20 days of trimetazidine treatment, an improvement in exercise testing parameters was seen in about 50% of patients, and the differences of the mean values were statistically significant. The patient response to the questionnaire administered following the treatment indicated a decreased frequency of anginal episodes and an increased exercise duration to the occurrence of angina in two thirds of patients, less requirement for nitrates in 40% of patients, and increased exercise tolerance in 50% of patients. In patients with subjective response to treatment, comparison of exercise testing parameters before and after treatment showed significant increase in the duration of exercise, time to ischemic changes in ECG, and the degree of ST segment depression during peak exercise. In patients with no subjective response to treatment, a statistically significant difference was seen in the double product only. Conclusions: After 20 days of treatment with trimetazidine added to maximal anti-ischemic treatment in patients with refractory angina, an improvement in exercise testing parameters and subjective response to treatment were seen in about 40% of patients. In patients with subjective response to treatment, exercise testing parameters improved significantly compared to the baseline values