Clinical Outcomes of Trimetazidine in Patients with Acute ST Segment Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention

Objective: Trimetazidine (TMZ) is considered as an antiischemic agent with anti-oxidant activity. The aim of this multicenter research is to evaluate the long-term effect of TMZ on rehospitalization, coronary restenosis, and left ventricular ejection fraction (LVEF) in patients with primary ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).
Methods: Six hundred and eighty STEMI patients (mean age 62.3, males: 82%) who underwent PPCI in 8 medical centers in Armenia from 2015 to 2016 were enrolled and randomly assigned to either with TMZ therapy (35 mg bid) (TMZ group, n = 440) or without TMZ (no-TMZ group, n = 240). All patients received standard therapy. LVEF was assessed at baseline and twice by the end of 3^rd and 6^th months. Rehospitalization was recorded by the end of 3^rd and 6^th months, and restenosis –by the end of 6^th month. Baseline clinical characteristics in the TMZ and no-TMZ groups were generally similar.
Results: By the end of 6^th month, the TMZ group showed a significant higher LVEF than the no-TMZ group (42.60±6.45% vs. 41.20±7.48%, p<0.036) and 3 fold lower restenosis rate (1.14±0.003% vs. 3.33±0.01%, p<0.046). There were no significant differences between the group in rehospitalization rates at 3 and 6-month follow-up respectively (5.23±0.01% vs. 8.33±0.03%, P>0.11 and 7.73±0.02% vs. 7.92±0.03%, P>0.93).
Conclusion: TMZ appeared to improve clinical outcomes in after-PPCI STEMI patients by significantly reducing restenosis rate and improving LVEF over 6 months.