Clinical benefits of trimetazidine in patients with recurrent angina.

In clinical practice there is a major problem with angina, which is resistant to medical therapy with hemodynamically acting agents. In that group of patients it is necessary to consider the indications for coronary angiography and percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass grafts (CABG). But some of these patients, especially those who had previous CABG or PTCA, coronary diabetic patients and elderly patients do not qualify for revascularization procedures. In patients with recurrent angina the beneficial effect of trimetazidine, a metabolic agent, that shifts cardiac energy metabolism from fatty acid oxidation to glucose oxidation was demonstrated. In the TRIMPOL II analysis of subgroup of post-revascularized patients with recurrent angina was demonstrated the improvement in exercise treadmill test parameters and clinical symptoms in a group treated with trimetazidine added to preexisting monotherapy with metoprolol in comparison with placebo plus metoprolol. The time to 1 mm ST-segment depression was increased with trimetazidine by 80s and was significantly greater than that recorded in the placebo group (465+/-143.8s vs 385.1+/-144.6s, P<0.01). The time to onset of angina was significantly greater for the group treated with trimetazidine in comparison with placebo (508.1+/-132.4 vs 433.6+/-164s, P=0.031). The total duration of exercise was significantly greater than that recorded for patients with placebo plus metoprolol (524.4+/-131.5 vs 466.9+/-144.8, P=0.048). A similarly significant observation was made regarding workload (10.1+/-2.4 vs 9+/-2.4 METs, P=0.035). The maximum ST-segment depression at peak exercise was significantly smaller in the trimetazidine group than in placebo group (1.4+/-0.8 vs 1.8+/-0.7 mm, P<0.01). The mean number of angina attacks per week was 1.7+/-2.3 for patients in the trimetazidine treated group, as compared with 3.1+/-2.9 for patients receiving placebo (P<0.01). The rate-pressure product at peak of exercise remained unchanged. The results suggest the rationale for metabolic therapy in post-revascularized patients with recurrent angina. Because no influence on heart rhythm, blood pressure, blood glucose level and excellent tolerability, trimetazidine may be also especially recommended for elderly and coronary diabetic patients, especially those with impaired left ventricular function.