Copyright © 1993 by the European Society of Cardiology.
© 1993 The European Society of Cardiology
Myocardial cytioritection during percutaneous transluminal coronary angioplasty
Clinic Nordrhein Ernst-Ludwig-Ring 2, D 6350 Bad Nauheim, Germany
Correspondence: G. Kober, Clinic Nordrhein, Ernst-Ludwig-Ring 2, D 6350 Bad Nauheim, Germany
Transluminal coronary angioplasty (PTCA) is a well defined controlled model inducing regional myocardial ischaemia in man. Direct cardiac anti-ischaemic effects of anti-anginal drugs can be assessed by intracoronary injection of small doses which do not affect systemic parameters.
Trimetazidine (TMZ) has recently been shown to improve anginal symptoms without modifying haemodynamic variables. A randomized, double-blind, placebo-controlled trial was conducted in 20 patients to study the effects of TMZ on the severity of myocardial ischaemia during PTCA of the left anterior descending coronary artery.
Five minutes after a first successful dilation (D0), a control balloon inflation (D1) was performed until onset of ischaemic signs on both the intracoronary (i.c.) and precordial ECG. Two minutes later, patients received either trimetazidine 6 mg or placebo i.e. Another inflation (D2) was performed 5 min after Dr
No differences were found between the two groups regarding responses in heart rate, systemic and i.c. pressures during the study. TMZ decreased maximum ST segment shift at D2), as compared to D1), (0.8±0.1 vs 1.4±0.3 mV, P = 0.023) and delayed its onset (46±4 vs 36±5 s, P = 0024). TMZ also decreased maximum T wave changes (1.06±0.24 vs 2.19±0.3 mV, P = 0.001), and significantly reduced the area under the curve (AUC:mV.s–1) of the i.c. ST segment and T wave changes during balloon inflation (P = 0.002 and P<0.001 respectively). Placebo had no effect on any of these parameters.
Group x time interaction was statistically significant for maximum changes in T wave amplitude (V i.c.):P = 0.007, for time to max ST changes in V i.c.:P = 0.009, and for the area under the curve of the i.c. ST segment and T wave changes: P = 0.042 and P = 0.003 respectively.
In the TMZ group, mean severity of angina decreased between D1, and D2 (2.2±1.0 vs 1.4±0.7), while in the placebo group the decrease was lower (2.2±0.6 at Dt vs 1.7±0.7 at D2). However, the difference between the two groups was not statistically significant (P = 0.170). No side-effects were reported on TMZ. No clinical complications occurred during catheter dilation.
These results support the hypothesis that trimetazidine has a direct anti-ischaemic effect on human myocardial cells.
Key Words: Trimetazidine • PTCA • myocardial cytoprotection • effort angina
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  A. Birand, G. Z. Kudaiberdieva, T. A. Batyraliev, F. Akgul, and A. Usal Effects of Trimetazidine on Heart Rate Variability and Left Ventricular Systolic Performance in Patients with Coronary Artery Disease After Percutaneous Transluminal Angioplasty Angiology, May 1, 1997; 48(5): 413 - 422. [Abstract] [PDF]
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