Protective effect of an acute oral loading dose of trimetazidine on myocardial injury following percutaneous coronary intervention

Objective: To evaluate the effect of pre-procedural acute oral administration of trimetazidine (TMZ) on percutaneous coronary intervention (PCI)-induced myocardial injury. Design: Single-centre, prospective, randomised evaluation study. Setting: Patients with stable angina pectoris and single-vessel disease undergoing PCI. Patients: 582 patients were prospectively randomised. Patients who underwent more than one inflation during PCI were excluded, resulting in 266 patients randomly assigned to 2 groups. Interventions: Patients were randomly assigned to receive or not an acute loading dose of 60 mg of TMZ prior to intervention. Main outcome: The frequency and the increase in the level of cardiac troponin Ic (cTnI) after successful PCI. cTnI levels were measured before and 6, 12, 18 and 24 h after PCI. Results: 136 patients were assigned to the TMZ group and 130 to the control group. Although no statistically significant difference was observed in the frequency of cTnI increase between the two groups, post-procedural cTnI levels were significantly reduced in the TMZ group at all time points ( 6 h: mean (SD) 4.2 (0.8) vs 1.7 ( 0.2), p < 0.001; 12 h: 5.5 (1.5) vs 2.3 ( 0.4), p, 0.001; 18 h: 9 ( 2.3) vs 3 ( 0.5), p, 0.001; and 24 h: 3.2 (1.2) vs 1 ( 0.5), p < 0.001). Moreover, the total amount of cTnI released after PCI, as assessed by the area under the curve of serial measurement, was significantly reduced in the TMZ group ( p< 0.05). Conclusion: Pre-procedural acute oral TMZ administration significantly reduces PCI-induced myocardial infarction.