The Investigation Of Trimetazidine On Myocardial Injury Following Percutaneous Coronary Intervention

ObjectivesTo evaluate the effect of peri-procedural administration of trimeta-zidine (TMZ) on PCI-induced myocardial injury in patients with coronary artery diseases.MethodsThis is a single-centre,prospective,randomized evaluation study. Between September 2008 and March 2009,patients with coronary artery disease were prospectively randomized to receive TMZ or not in the Cardiology Department,Zhongshan Hospital,Fudan University.The patients included stable angina pectoris,unstable angina pectoris,and healed myocardial infarction.Venous blood samples for measurement of cardiac troponin T(cTnT), High-sensitivity C reactive protein(hsCRP) and Amino-terminal pro-Brain natriuretic peptide(NT-proBNP) were collected from all patients before PCI and at 8 and 24h after the procedure.Patients in the TMZ group received an acute loading dose(60mg) of TMZ orally,at 8Pm the day before PCI and then 20mg tid until 24h after the procedure.The levels of cTnT and hsCRP were measured before and 8,16 h after PCI.The levels of NT-proBNP were measured before and 8h after PCI.The clinical end points,included myocardial infarction,death,and re-admission rate at one month were followed.The statistical analysis was performed using SPSS V.11.5 software. Comparisons between the two groups were performed using Student' s t tests or the Rank-sum test for continuous variables as appropriate,x~2Tests or Fisher's exact tests were used for categorical variables. ResultsA total of 116 patients were enrolled,12 patients who didn't complete the PCI successfully were excluded,resulting in 103 patients randomly assigned to 2 groups.48 patients were assigned to the TMZ group and 55 to the control group.Patients in the TMZ group had a higher prevalence of risks factors for coronary artery disease including unstable angina pectoris and high body mass index,32(66.7%) vs 25(43.6%) patients, p＜0.05 and 26.3+1.6 vs 25.2+2.0,p＜0.05,respectively.There was no difference in other baseline characteristics between the two groups. There was no difference in the levels of cTn,IisCRPn,NT-proBNP before PCI between the two groups.The frequency of patients with an increase in cTnl above the upper limit of the control range(＜0.03 ng/ml) was lower in the TMZ group,12(25%) vs27(49.1%),p＜0.05.Post-procedural cTnl levels were significantly reduced in the TMZ group at 16h,45.24 vs57.90,p＜0.05 (Rank-sum test ).Post-procedural logNT-proBNP levels at 8h and Post-procedural hsCRP levels at 16h were higher after PCI; Post-procedural logNT-proBNP and hsCRP levels were more higher in the control group,2.4+0.5 vs 2.1+0.5,p＜0.05;2.8+2.1 vs 1.7+1.6, p＜0.01,respectively.At one month follow-up,there was no significant difference in myocardial infarction,death,and re-admission rate between the two groups.There was one patient Withdrawal out of the research due to suspected diarrhea. There were no instances of serious adverse events in other patients during the in-hospital and one month post-discharge follow-up.ConclusionsPeri-procedural administration of oral TMZ significantly reduced PCI-induced myocardial injury,decreased inflammation,and improved myocardial function.