Trimetazidine fails to improve angina symptoms and outcomes after PCI: Lancet

PCI improves prognosis in acute patients and can alleviate symptoms in chronic patients who do not respond to medication. However, previous studies have shown that angina recurs in 30% of patients despite antianginal therapy and successful PCI. There are limited contemporary data on the prognostic benefits of antianginal drugs in post-PCI patients.

The randomised ATPCI trial investigated the impact of trimetazidine added to standard therapy after PCI. Unlike typical angina medications, which improve blood flow by relaxing and widening the blood vessels, trimetazidine protects against myocardial ischaemia by improving the heart's metabolism and favouring the use of glucose.

The trial 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.

The primary efficacy endpoint was the composite of cardiac death; or hospitalisation 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 five 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=0.7). There was no difference between groups in the rate of side effects.

Principal investigator Professor Roberto Ferrari of the University of Ferrara, Italy said: "The trial shows that trimetazidine does not improve outcomes or symptoms after successful PCI in patients with acute and chronic coronary syndromes."