The ATPCI trial results demonstrate that trimetazidine given post successful percutaneous coronary intervention (PCI) doesn’t improve outcomes in patients with chronic or acute coronary syndromes.
Recently reported in a Hot Line session recently at the ESC Congress 2020, this trial was designed to help patients with angina, that condition involving often contracting pain or distress experienced in the chest or in other area of the body such as the neck or jaw, due to a reduction in blood circulation to the heart. Often occurring during acute coronary syndromes (ACS) and chronic coronary syndromes (CCS), PCI can improve an acute patient’s prospects and hopefully, improve symptoms for those chronic patient’s not responding to drugs. One major challenge facing this patient: 30% of them will face a recurrence of angina despite antianginal therapy and successful PCI. Moreover, the data on prognostic benefits of antianginal drugs in post-PCI patients is presently limited.
What is Trimetazidine?
This is a drug developed to address angina and sold under many trade names. Its described as the first cytoprotective anti-ischemic agent developed and marketed by Servier, a French pharmaceutical company. It’s an anti-ischemic (anti-anginal) metabolic agent that was developed to improve myocardial glucose utilization via inhibition of fatty acid metabolism, known as fatty acid oxidation inhibition.
This drug is most often prescribed as a long-term treatment of angina pectoris and in some nations (including France) for tinnitus and dizziness. In 2012, the European Medicines Agency (EMA) recommended restricting the use of trimetazidine-containing medicines just as an additional treatment of angina pectoris in case of inadequate control by or intolerance to first-line antianginal therapies.
This randomized study, published in EU Clinical Trials Register, was known as the ATPCI trial assessing the impact of trimetazidine in addition to standard therapy post PCI. Trimetazidine doesn’t widen and relax blood vessels like most angina medications; rather, the drug was designed to improve the heart’s metabolism while favoring the use of glucose.
The study team randomly assigned a total of 6,007 patients: those who had recently went through successful PCI, to either the trimetazidine or placebo arm of the study. These patients were segmented into those that opted for an elective PCI (n=3,490) or those urgent situations involving unstable angina or non-ST-elevation myocardial infarction (n-2,517).
The study protocol established a primary efficacy endpoint as the composite of cardiac death or hospitalization due to a cardiac event or ongoing angina, which led to the changing of dosage or actual antianginal drug or coronary angiography.
The study’s principal investigator and a Professor with the University of Ferrara, Roberto Ferrari, was quoted, “The trial shows that trimetazidine does not improve outcomes or symptoms after successful PCI in patients with acute and chronic coronary syndromes.”
Jean Pascal Challeton, MD
Anne Correges, MSc
Call to Action: For further details of this study also refer to the European Society of Cardiology.