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August 30, 2020

Impact of Angina Drug Trimetazidine Evaluated After Successful PCI Revascularization

August 30, 2020—Trimetazidine administered after a successful percutaneous coronary intervention (PCI) does not improve outcomes in patients with chronic or acute coronary syndromes, concluded investigators in the ATPCI trial, which was sponsored by I.R.I.S., Institut de Recherches Internationales Servier based in Suresnes, France.

The European Society of Cardiology announced that results of the ATPCI trial were presented in a Hot Line session at ESC Congress 2020—The Digital Experience held online as a virtual event August 29 to September 1, 2020.

According to ESC, the randomized ATPCI trial evaluated the impact of trimetazidine added to standard therapy after PCI. Unlike typical angina medications that improve blood flow by relaxing and widening the blood vessels, trimetazidine protects against myocardial ischemia by improving the heart’s metabolism and favoring the use of glucose.

The ATPCI trial (European Union Clinical Trials Register, 2010-022134-89) enrolled 6,007 patients who had undergone successful PCI, either elective for stable angina (n = 3,490) or urgent for unstable angina or non-ST-elevation myocardial infarction (n = 2,517). Patients were randomly assigned to trimetazidine or placebo.

As summarized by ESC, the study’s primary efficacy endpoint was the composite of cardiac death; or hospitalization for a cardiac event; or recurrent/persistent angina leading to adding, switching, or increasing the dose of antianginal drugs or coronary angiography.

After a median follow-up of 5 years, the primary efficacy endpoint occurred in 700 (23.3%) patients in the trimetazidine group and 714 (23.7%) patients in the placebo group (P = .7). There was no difference between groups in the rate of side effects.

“The trial shows that trimetazidine does not improve outcomes or symptoms after successful PCI in patients with acute and chronic coronary syndromes,” commented the study’s principal investigator Professor Roberto Ferrari, MD, of the University of Ferrara, Italy in the ESC announcement.

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