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European Heart Journal 1993 14(Supplement G):18-24; doi:10.1093/eurheartj/14.suppl_G.18
Copyright © 1993 by the European Society of Cardiology.
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© 1993 The European Society of Cardiology

Clinical features of an anti-anginal drug in angina pectoris

J. M. Detry

Service de Pathologie Cardiovasculaire, Départment de Médecine Interne, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc Avenue Hippocrate 10, UCL 10/28.81, 1200 Bruxelles, Belgium

Correspondence: Pr Jean-Marie Detry, Service de Pathologie Cardiovasculaire, Départemenl de Médecine Interne, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc. Avenue Hippocrate 10, UCL 10/28.81, 1200 Bruxelles, Belgium

Trimetazidine (TMZ) exerts anti-ischaemic effects without any associated central haemodynamic change, both at rest and with exercise. These findings suggest that TMZ has a direct cytoprotective effect, the efficacy of which has been confirmed by clinical studies in effort angina.

TMZ as monotherapy when compared with placebo, in acute (60 mg) as well as in chronic (20 mg t.i.d.) administration, significantly improves exercise tolerance: total work, duration of exercise and time to 1 mm ST segment depression, without changing the rate-pressure product. Moreover, during chronic treatment TMZ decreases the rale of anginal attacks.

In patients with coronary heart disease insufficiently controlled with nifedipine or a beta-blocker as monotherapy, the addition of TMZ (20 mg t.i.d.) significantly reduces the number of anginal attacks and improves exercise capacity. TMZ antianginal activity in monotherapy has also been compared in double-blind controlled studies with that of a calcium channel antagonist and a beta-blocker as reference drugs. TMZ is as efficient as nifedipine or propranolol on clinical variables as well as on ergometric criteria, but unlike these two reference drugs, which act through a haemodynamic mechanism, TMZ does not decrease rate-pressure product. Furthermore, in the study comparing TMZ with propranolol, TMZ was shown to decrease ischaemic episodes recorded by ECG ambulatory monitoring. These data show that TMZ belongs to the major antianginal agents available today. However, the absence of central haemodynamic effects suggests that the drug has a novel anti-ischaemic mechanism involving direct myocardial cytoprotection.

Key Words: Angina pectoris • ischaemia • treatment • trimetazidine


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