Effect of early Trimetazidine on infarct size in ST-segment-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

Abstract

\n Purpose: Trimetazidine, a metabolic agent with anti-ischemic effects, was reported to reduce reperfusion injury in animal models. In this randomized double-blind placebo-controlled trial, we investigated the effects of trimetazidine on reducing infarction size in patients undergoing revascularization for ST-segment elevation myocardial infarction (STEMI). Methods: Patients with STEMI randomly received trimetazidine (n=87) or placebo (n= 86) in a double-blind manner before primary percutaneous coronary intervention (PCI), and study treatment was maintained for 12 months after the procedure. The primary endpoint was infarction size measured by cardiac magnetic resonance (CMR) after primary PCI. Results: The clinical characteristics of patients (90% male, mean age 57±12 years) in both groups were well-matched on the baseline. Compared with patients in control group, the percentage and weight of infarction size of patients in trimetazidine group were both significantly lower (22.1±11.8% [n =74] vs. 26.9±11.9% [n=74], p=0.010; 28±18g [n =74] vs. 35±19g [n=74], p=0.022), the myocardial microvascular obstruction (MVO) rate measured by CMR was lower in trimetazidine group (29.7% [22/7] vs. 52.7% [39/74], p=0.007), while myocardial salvage index (MSI) was significantly higher in trimetazidine group (48±20% vs. 39±27%, p=0.008). The incidence of readmission due to aggravated heart failure in trimetazidine group was lower than that in the control group without significance (8.0% vs 14.0%, p=0.234). Conclusions: Our study provides suggests that trimetazidine initiated prior to primary PCI, improves myocardial infarct size, MVO and MSI, possibly by reducing reperfusion injury.