The Effect Of Trimetazidine In Patients With AMI After PCI

Background Percutaneous coronary intervention technique is the most effectivetherapy method in acute myocardial infarction patients, which can restore infarctionrelated coronary blood flow as soon as possible, save damaged myocardium, reduce theinfarction area and the restoration of cardiac function, improve the long-term prognosisof patients and the quality of life. However, some patients did not benefit from it，postoperative complications such as myocardial injury and adverse cardiovascular eventsis still relatively common, which may be closely relevant to myocardial ischemiareperfusion injury aroused by myocardial microcirculation obstruct. This study aims toprovide some myocardial energy metabolism drugs before and after PCI which couldimprove myocardial microcirculation perfusion and reduce ischemic myocardium injuryand the occurrence of postoperative adverse cardiovascular events so as to eventuallyimprove the clinical prognosis of patients.Objective The purpose of this research is to Study the myocardial protectiveeffects of trimetazidine On orally administratment trimetazidine60mg load dosagebefore PCI and long-term use of TMZ (20mg tid) in patients with AMI after PCI, Byobserving the level of PCI TIMI flow classification and target vessel no-reflowphenomenon (NR), serum cardiac troponin I (cTnI), high sensitive C-reactiveprotein(hs-CRP), left ventricular ejection fraction (LVEF) and left ventricular fractionshortening (LVFS). Further through telephone follow-up of PCI postoperative recurrenceof angina symptoms and Major Adverse Cardiac Events (MACE, including readmission,myocardial infarction, death, etc.), We investigate the influence of trimetazidine inpatients with myocardial ischemia injury and its possibly protective mechanism afterPCI.Method35patients who undergoing PCI for AMI at our department from October2013to January2014were included into this study, including24cases of maleand11cases of female. The research applied synchronization parallel antithesis andself-cross-reference cohort study.35patients with AMI were randomized into two groups:18cases in treatment group were orally administrated trimetazidine60mg load dosagebefore PCI and20mg tid long-term use after operation.17cases in control group, whichonly accepted routine treatment. Two groups use the same routine treatments such asantiplatelet agents, anticoagulation, β-blockers and ACEI, statins, nitrate and otherconventional drug treatment. Observing and recording the PCI TIMI flow grade and NR,and levels of cTnI、hs-CRP which were measured before and after PCI, determinatingLVEF and LVFS before and after PCI by cardiac color ultrasound examination. Andfollow-up three months by telephone to understand the two groups of patients recurrenceof angina symptoms and MACE.Results Determination of cTnI levels: there was no difference in the level of cTnIbetween the two groups of before PCI (P>0.05).The level of cTnI in two groups at24h、48h after PCI elevated obviously, which compared with before PCI and had significantdifference (P<0.05). the elevated cTnI was higher in the Control group than in the TMZgroup (P<0.05). Determination of hs-CRP concentration: the hs-CRP level of before PCIwas similar in both the Control and TMZ groups (P>0.05), hs-CRP level at48hour afterPCI was higher than baseline level (P<0.05), the elevated hs-CRP was higher in theControl group than in the TMZ group (P<0.05). The rate of TIMI III flow of coronaryblood in TMZ group were higher than in control group, but which was no significantdifference (P>0.05), no-reflow rate in the TMZ group is lower than the control group andthe two groups was significantly difference (P>0.05). Echocardiographic measurement:the level of LVEF and LVFS in the third months after PCI in TMZ group weresignificantly increased compare to before PCI (P<0.05). While in the Control group ithad no difference (P>0.05). TMZ group is higher than the control group (P<0.05). Ataverage three months follow-up, symptoms of recurrent angina after PCI weresignificantly reduced in the TMZ group than the control group (P<0.05). TMZ group of patients the incidence of MACE in the TMZ group is better than the control group, butwhich was no significant difference (P>0.05).Conclusion1. TMZ can reduce the post-PCI cTnI、 hs-CRP release and furtherimprove the coronary blood circulation、 left ventricular function, which indicated thatTMZ may reduce the post-PCI inflammatory reaction, reduce ischemic myocardial injurycaused by lipid peroxidation with oxygen free radicals and improve myocardialmicrocirculation and the left ventricular function. TMZ is regard as a cardioprotectiveagent for the prevention of myocardioal ischaemia.2. Long-term use of TMZ can adjustthe ways of myocardial cell metabolism to improve the symptoms of angina pectoris,reducing the frequency of recurrence of angina symptoms, improve the long-termprognosis and quality of life in patients after PCI.