Meta-anaysis Of The Cardioprotective Effect Of Trimetazidine During Percutaneous Coronary Intervention

Background and Objective:The operation of percutaneous coronary intervention (PCI) can induce coronary spasm, endothelial cell injury and the debris of atherosclerotic plaque or thrombus may cause coronary artery distal embolization, thereby resulting in myocardial ischemia or myocardial injury. The measures concerning cardioprotection during PCI procedure is of intriguing interest and has become one of the research hot topics in cardiology. The efficiency and safety of trimetazidine has been widely recognized in the treatment of patients with coronary artery disease (CAD). However, due to lack of sufficient evidence in clinical conditions, there is still doubt whether the administration of trimetazidine to patients undergoing PCI operation can minimize the myocardial ischemia or injure following successful PCI procedure. We aimed to performe a meta-analysis to evaluate the cardioprotective effect of trimetazidine on patients who underwent successful PCI.Methods:We systematically searched the literatures through the PubMed and Cochrane Central Registry of Clinical Trials for the published randomized controlled clinical trials (published from Jan1980to Dec2012) concerning the administration of trimetazidine to patients before and after PCI operations. The search terms including ’trimetazidine’ or ’vasorel’ and ’percutaneous coronary intervention’or’reperfusion’ or ’myocardio damage’. Data concerning the study design, patient characteristics, and outcomes were reviewed and extracted. The meta-analysis was performed using a software of RevMan5.1.7to evaluate the incidences of ischemic ST-T changes on electrocardiogram (ECG) and angina attacks during PCI, the incidence of elevated cardiac troponin I (cTnI) within24hours after PCI, and also the changes of left ventricular ejection fraction (LVEF)30days after PCI procedure.Results:1) We reviewed a total of458articles and183articles were randomized controlled clinical trials. Five trials which enrolled514patients with CAD were in accordance with the inclusion criteria and were included in this meta-analysis. Among of them,265subjects received trimetazidine (the trimetazidine group) and249subjects received placebos (the control group).2) The incidence of ischemic ST-T changes on ECG during the PCI procedure was assessed in2trials (including514patients in all,265patients in the trimetazidine group and249patients in the control group). The meta-analysis showed that the incidence of ischemic ST-T changes in the trimetazidine group was significantly lower than that in the control group (32.1%vs41.2%, OR:0.60,95%CI:0.37-0.95, P=0.03).3) The occurrence of angina attacks during the PCI procedure was evaluated in2trials (including145subjects,76subjects in the trimetazidine group and69patients in the control group). The results demonstrated that the incidence of angina attacks in the trimetazidine group was markedly lower than that in the control group (15.8%vs43.5%, OR:0.16,95%CI:0.67-0.38, P<0.0001).4) Three trials (204patients in all,107patients in the trimetazidine group and97patients in the control group) measured the LVEF values30days after the PCI procedure. The meta-analysis found that the mean value of LVEF in the trimetazidine group was significantly higher than that in the control group (WMD:4.60,95%CI:2.68-6.53, P<0.00001).5) A total of3trials (including362patients,185cases in the trimetazidine group and177cases in the control group) analysed the incidence of elevated cTnI≥2times the upper limit of normal, which was measured24hours after the PCI procedure. Although the meta-analysis demonstrated no significant difference between the trimetazidine group and the control group (24.3%vs28.8%, OR:0.43,95%CI:0.28-1.45, P=0.28), the cTnI measures tested on different time points following PCI precedures all showed much lower in the trimetazidine group than those in the control group in all the3trials (all P<0.05).Conclusion:Administration of trimetazidine before and after PCI provides a significant benefit over placebo in reducing the incidence of ischemic ST-T changes and angina attacks during the procedure, and improving the left ventricular systolic function after the procedure. The lack of evidence for reducing the incidence of elevated cTnI≥2times the upper limit of normal might be partly attributed to the small amout of trials and patients enrolled in this study.