Can we improve
the management of angina patients after
percutaneous coronary intervention?
Beneficial effects of adding trimetazidine MR therapy
after PCI in multivessel coronary heart disease
patients with diabetes mellitus
PCI: percutaneous coronary intervention
XU X et al. Clin Drug Investig (2014) 34:251–258
Treating angina by exclusively targeting
coronary obstruction is insufficient
Boden et al. (COURAGE Study). N Engl J Med. 2007;356:1503-1516.
Beneficial effects of trimetazidine therapy
in CHD patients after PCI
Methods
 700 coronary heart disease (CHD) patients with diabetes mellitus (DM) who were
aged 65 years and undergoing coronary angiography were randomized.
Half of them received trimetazidine 20 mg three times daily after stent implantation
as an addition to conventional CHD treatment. The other half received conventional
treatment alone (approx. 70% of patients were taking -blockers).
 Primary end point:
 Incidence of recurrent angina pectoris
 measures of various echocardiographic parameters.
XU X et al. Clin Drug Investig (2014) 34:251–258
Beneficial effects of trimetazidine therapy
in CHD patients after PCI
Results
Compared with the control group, trimetazidine significantly reduced recurrent angina
pectoris (P=0.010) and silent myocardial ischemia (P=0.009).
XU X et al. Clin Drug Investig (2014) 34:251–258
Beneficial effects of trimetazidine therapy
in CHD patients after PCI
Results
Left ventricular function and left ventricular structure were both relatively stable in
trimetazidine-treated patients after 2 years of follow-up, while they deteriorated in the
control group with a significant difference between groups (all P<0.01).
XU X et al. Clin Drug Investig (2014) 34:251–258
Beneficial effects of trimetazidine therapy
in CHD patients after PCI
Results
Independent predictors of recurrent angina pectoris in the 2 years following PCI
included three-vessel disease, current smoking, BMI, and history of hypertension and
hypercholesterolemia, while trimetazidine treatment had a beneficial effect.
Trimetazidine:
a predictor of protection
XU X et al. Clin Drug Investig (2014) 34:251–258
Beneficial effects of trimetazidine therapy
in CHD patients after PCI
Discussion
XU X et al. Clin Drug Investig (2014) 34:251–258
Conclusion
 About one-third of patients still have angina after myocardial
revascularization.
 Trimetazidine effectively reduces recurrent angina and preserves left
ventricular function in patients with multivessel CHD and DM.
 These benefits could be linked to the mode of action of trimetazidine MR.
By directly providing a 33% increase in the energy supplied to the cardiac
cells, trimetazidine MR effectively reduces angina and provides unique
cardioprotective benefits.