Improving survival
in symptomatic ischemic patients with
left ventricular dysfunction
Beneficial effects of
long-term trimetazidine* therapy
*Trimetazidine is indicated by the European Medecines Agency (EMA) as add-on therapy for the symptomatic treatment of patients with stable
angina pectoris who are inadequately controlled by or intolerant to first-line antianginal therapies.
Fragasso G et al. Int J Cardiol. In press.
What do preliminary data say?
El-Kady
Study
Fragasso
Study
Di Napoli
Study
METRO
Study
2005
2006
2007
2009
n=200
Angina patients
with ischemic
left ventricular
dysfunction
=> First data on
mortality
evaluated as a
safety parameter
n=65
Patients with
heart failure
n=61
Patients with
severe ischemic
cardiomyopathy
=> First results
on mortality in
a small
population
=> Complementary results on
mortality in a
small
population
n=number of patients.
El Kady T et al. Am J Cardiovasc Drugs. 2005;5:271-278.
Di Napoli P et al. J Cardiovasc Pharmacol. 2007;50:585-589.
Fragasso et al. J Am Coll Cardiol. 2006;48:992-998.
Gao
Zhang
meta-analysis meta-analysis
n=353
Angina patients
with acute
myocardial
infarction
=> Primary
objective was
to assess the
6-month
survival rate
2011
n=955
Heart failure
patients
2012
n=884
Heart failure
patients
=> First metaanalysis
demonstrating
mortality
results
A study with a homogeneous and
relevantly sized population is needed.
Iyengar S et al. Am J Cardiovasc Drugs. 2009;9:293-297.
Gao D et al. Heart. 2011;97(4):278-286.
Zhang L et al. J Am Coll Cardiol. 2012;59:913-922.
Kim J et al. WCC 2012. Abstract 1621.
A new study designed to evaluate survival
669 Symptomatic heart failure patients
• International multicenter retrospective cohort study
• Inclusion criteria:
– Ejection fraction ≤ 45%
– NYHA Class II-IV
– Trimetazidine (TMZ) administered if symptoms persist despite correct
titration of standard medical therapy for chronic heart failure (CHF)
•
CHF was of ischemic origin in >80% of patients
• Mean follow-up: 3 years
• Propensity score
Fragasso G et al. Int J Cardiol. In press.
TMZ improves survival
Event-free survival
Global survival
TMZ significantly improves global survival by 11.3%
(P=0.015).
Fragasso G et al. Int J Cardiol. In press.
TMZ reduces global and cardiovascular
mortality
Heart failure patients live longer with TMZ.
Fragasso G et al. Int J Cardiol. In press.
TMZ reduces rate of hospitalization
for cardiovascular causes
Heart failure patients live better with TMZ.
Fragasso G et al. Int J Cardiol. In press.
Conclusion:
• The addition of TMZ to standard medical therapy in patients with
CHF significantly reduces total and cardiovascular mortality and
improves event-free survival.
• Therefore, this study confirms in a homogeneous and relevantly
sized population that TMZ should be considered as a potential
additional medication to standard therapy in CHF patients.
• These results could be explained by the ability of TMZ to reduce
ischemia whatever the causal mechanism, and therefore to
protect the heart from subsequent damage.
Fragasso G et al. Int J Cardiol. In press.