P4293Trimetazidine modified release therapy in post-myocardial infarction patients with multivessel disease having undergone incomplete revascularization: results of two years of follow up

Abstract

Background: Previously we demonstrated that one-year trimetazidine modified release (TMZ MR) therapy reduced the rate of ischemia-driven revascularization of non-infarct artery lesions or repeat hospitalization in post-myocardial infarction patients with multivessel disease having undergone incomplete revascularization. The aim of this study was to examine whether these positive effects of TMZ MR will remain during the second year of therapy. Method(s): 100 post-myocardial infarction patients with multivessel disease after incomplete revascularization were included into a one-year, prospective, randomized, placebo-controlled clinical trial. TMZ MR 35 mg bid was added to the conventional therapy before discharge from the hospital. The primary end-point of this study was a composite of ischemia-driven revascularization of non-infarct artery lesions and repeat hospitalization. After the unblinding half of trial participants continued the TMZ MR therapy in an open manner for another year, others received the conventional treatment only. Result(s): Baseline clinical, hemodynamic and angiographic characteristics were the same in the TMZ MR group and the placebo group of post-myocardial infarction patients with multivessel disease having undergone incomplete revascularization. Over the second year of follow-up, the TMZ MR therapy when compared with the conventional treatment was characterized by a further significant reduction of ischemia-driven revascularization of non-infarct artery lesions or repeat hospitalization (RR 0.53; 95% CI, 0.34-0.85, p<0.005) (Figure), again mainly due to a reduction of the repeat hospitalization rate (20% vs. 50% in the group of the conventional treatment only, p<0.03). Conclusion(s): Trimetazidine modified release therapy can be considered an effective tool to manage post-myocardial infarction patients with multivessel disease having undergone incomplete revascularization. The ongoing ATPCI (efficAcy and safety of Trimetazidine in Patients with angina pectoris having been treated by percutaneous Coronary Interventions) trial will shed light on this issue. (Figure Presented).