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Early Trimetazidine Therapy in Patients Undergoing Primary Percutaneous Coronary Intervention for ST Segment Elevation Myocardial Infarction Reduces Myocardial Infarction Size

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Abstract

Purpose

Trimetazidine, a metabolic agent with anti-ischemic effects, was reported to reduce reperfusion injury in animal models. In this randomized double-blind placebo-controlled trial, we investigated the effects of trimetazidine on the reduction of infarction size in patients undergoing revascularization for ST segment elevation myocardial infarction (STEMI).

Methods

Patients with STEMI randomly received trimetazidine (n = 87) or placebo (n = 86) before primary percutaneous coronary intervention (PCI), and subsequently received oral trimetazidine or placebo for 12 months after reperfusion. The predefined primary endpoint was infarction size on cardiac magnetic resonance (CMR) performed at 7 days after primary PCI. The trial was registered on www.clinicaltrials.gov (registration number: NCT02826616).

Results

The clinical characteristics of the patients in both groups were well-matched at baseline. At 7 days after primary PCI, the percentage and absolute infarction size in the trimetazidine group were significantly smaller than those in the control group (22% ± 12% [n = 74] vs. 27% ± 13% [n = 74], p = 0.011 and 28 ± 18 g [n = 74] vs. 35 ± 19 g [n = 74], p = 0.022, respectively), and the incidence of myocardial microvascular obstruction (MVO) measured by CMR was significantly reduced in the trimetazidine group (29.7% [22/74] vs. 52.7% [39/74], p = 0.005). The myocardial salvage index (MSI) measured by CMR was significantly higher in the trimetazidine group (48% ± 20% vs. 39% ± 20%, p = 0.008). The incidence of readmission due to aggravated heart failure did not differ significantly between the trimetazidine group and the control group (8.0% vs. 14.0%, p = 0.234).

Conclusions

In patients with STEMI undergoing primary PCI, early trimetazidine before reperfusion reduced myocardial infarction size and MVO, and improved MSI.

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Availability of Data and Material

All participants were enrolled at the Department of Cardiology in the Chinese PLA General Hospital. The data underlying this article will be shared on reasonable request to the corresponding author.

Code Availability

Not applicable.

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Acknowledgments

The authors thank Alison Sherwin, PhD, from Liwen Bianji (Edanz), Zhnag Ying, MD and Tian Lichao, MD from Chinese PLA General Hospital for editing the English text of a draft of this manuscript.

Funding

This study was supported by the Research Fund for Cardiac Rehabilitation and Metabolic Therapy (CCA-CRMT-1707) and the Coronary Microvascular Disease Innovation Foundation (2018-CCA-CMVD-04).

Author information

Authors and Affiliations

  1. Department of Cardiology, Chinese PLA General Hospital, 28 Fuxing Street, Beijing, 100853, China

    Geng Qian, Xin A, Xiaosi Jiang, Zichao Jiang, Tao Li, Wei Dong, Jun Guo & Yundai Chen

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  1. Geng Qian
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  2. Xin A
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  3. Xiaosi Jiang
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  8. Yundai Chen
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Contributions

We hereby declare that all authors meet the authorship criteria with the following roles. Qian Geng: Conception and design, data collection, analysis and manuscript drafting; A Xin and Jiang Zichao: Performance of interventional procedures and data collection; Jiang Xiaosi: Data analysis. Li Tao: Data collection and analysis; Dong Wei: Statistical analysis and data collection; Guo Jun: Data collection and revision of the manuscript. Chen Yundai is the guarantor of the entire manuscript, and contributed to the study design and supervision. All authors approved the final manuscript.

Corresponding authors

Correspondence to Geng Qian or Yundai Chen.

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Ethics Approval

The trial was registered on www.clinicaltrials.gov (registration number: NCT02826616). The study protocol was approved by the Ethics Committee of Chinese PLA General Hospital.

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All participants provided written informed consent.

Conflict of Interest

The authors declare that there are no conflicts of interest.

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Qian, G., A, X., Jiang, X. et al. Early Trimetazidine Therapy in Patients Undergoing Primary Percutaneous Coronary Intervention for ST Segment Elevation Myocardial Infarction Reduces Myocardial Infarction Size. Cardiovasc Drugs Ther 37, 497–506 (2023). https://doi.org/10.1007/s10557-021-07259-y

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