PCI: Trimetazidine does not lead to fewer cardiac events

Patients under successful PCI for angina pectoris and acute coronary syndrome without ST elevation have good long-term results with optimal medical therapy. In the ATPCI study, the routine use of trimetazidine did not lead to a reduction in cardiac events in this patient group.

Clear results from the ATPCI study

Patients undergoing successful percutaneous coronary intervention (PCI) for angina pectoris and acute coronary syndrome without ST elevation have good long-term results with optimal medical therapy. In the ATPCI study1, the routine use of trimetazidine did not lead to a reduction in cardiac events in this patient group. These results, presented at the ESC 2020 by Prof. Roberto Ferrari (University of Ferrara, Italy), were simultaneously published in The Lancet2.

There is little evidence of the prognostic benefit of antianginal drugs such as trimetazidine after a percutaneous coronary intervention (PCI). The ATPCI study presented by Prof. Ferrari aimed to assess the long-term potential benefit and safety of trimetazidine, administered in addition to standard medical treatment according to guidelines, in a cohort of 6,007 subjects who had recently experienced PCI with stable or unstable angina pectoris, or myocardial infarction without ST elevation.

After a median follow-up of 47.5 months, trimetazidine did not improve the primary endpoint, consisting of cardiac death, hospitalization for cardiac events, recurrence, or existence of angina pectoris incidence, compared to placebo treatment (23.3 vs. 23.7%; HR 0.98; P=0.73). No significant differences were observed between treatment groups with regard to the individual components of the primary endpoint either. Similar results were found in sub-analyses after elective or urgent PCI. The long-term use of trimetazidine did not lead to any safety problems. 

The routine use of 35mg orally administered trimetazidine twice daily for several years in subjects receiving optimal drug therapy after successful angioplasty does not affect angina pectoris recurrence or treatment outcome. These findings should be considered when discussing the role of trimetazidine in clinical practice.

References:
1. Ferrari R. TPCI - Trimetazidine in Angina Patients with Recent Successful Percutaneous Coronary Intervention: a Randomized, Double-Blind, Placebo-Controlled Trial. Hot Line 2 session, ESC Congress 2020, 30 Aug.
2. Ferrari R, et al Efficacy and safety of trimetazidine after percutaneous coronary intervention (ATPCI): a randomised, double-blind, placebo-controlled trial. Lancet 2020, August 30th DOI: 10.1016/S0140-6736(20)31790-6.

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