ESC 2020 | Post PCI Trimetazidine: No Adverse Events or Great Benefits

Trimetazidine in addition to optimal medical therapy in patients undergoing coronary PCI does not change events rate at long term. 

The ATPCI study was presented at ESC 2020 and simultaneously published in the Lancet. This study randomized coronary PCI patients with stable or acute NSTEMI coronary syndromes to trimetazidine vs. placebo.  

What is the rationale behind the use of trimetazidine? Unlike the first and second line drugs most habitually used, trimetazidine is the only one with no hemodynamic effect (it does not affect cardiac rhythm, systolic or diastolic pressure, or pre and afterload).  Trimetazidine improves the metabolism of the ischemic myocardium. 

Despite its interesting action mechanism, researchers, somewhat disappointed, have confirmed the drug does not show benefits at mean 5-year followup. 

Read also: ESC 2020 | Against the Grain, ASA Monotherapy Appears Superior after TAVR.

The ATPCI included 6007 patients (mean age 61) randomized after successful PCI to trimetazidine 35 mg every 12 hrs. vs placebo.

Primary efficacy end point included cardiac death, rehospitalization for cardiac event, recurrent or persistent angina requiring addition or change of dose of at least one antianginal drug, or coronary angiogram. 

After nearly 5 years, primary end point incidence was practically identical between groups (23.3% vs 23.7%; p=0.73). Neither were there differences when looking at components separately. 

Read also: ESC 2020 | New Drug Improves Functional Capacity in Hypertrophic Cardiomyopathy.

The ESC 2019 guidelines had classified trimetazidine (class IIa) as a second line drug in patients with angina. 

ATPCI-full

Original Title: Efficacy and safety of trimetazidine after percutaneous coronary intervention (ATPCI): a randomized, double-blind, placebo-controlled trial.

Reference: Ferrari R et al. Lancet 2020 Aug 28;S0140-6736(20)31790-6. Presentado en forma virtual en el congreso de la ESC 2020.

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