ATPCI: Does Routine Use of Trimetazidine Improve Patient Outcomes After Successful PCI?

Routine use of oral trimetazidine added to guideline-recommended medical therapy did not improve patient outcomes following a successful percutaneous coronary intervention (PCI), based on findings from the ATPCI trial presented at ESC Congress 2020 and simultaneously published in The Lancet. However, researchers led by Roberto Ferrari, MD, noted the long-term prescription of trimetazidine was not associated with any significant safety concerns.

The ATPCI trial randomly assigned 6,007 patients who had undergone successful PCI at 365 centers in 27 countries across Europe, South America, Asia and North Africa to either oral trimetazidine (35 mg/twice daily) or placebo. Eligible patients ranged in age from 21-85 tears and had either undergone elective PCI for stable angina or urgent PCI for unstable angina or non-ST segment elevation myocardial infarction less than 30 days before randomization. The primary endpoint was a composite of cardiac death; hospital admission for a cardiac event; recurrence or persistence of angina requiring an addition, switch, or increase of the dose of at least one anti-anginal drug; or recurrence or persistence of angina requiring a coronary angiography.

After a median follow-up of 47.5 months, the incidence of primary endpoint events was not significantly different between the trimetazidine group (23.3%) compared with the placebo group (23.7%). When analyzed individually, researchers also observed no significant differences in the incidence of the components of the primary endpoint between the two groups. Additionally, researchers noted similar results when patients were categorized by elective or urgent PCI. The frequency of adverse events was also similar between the groups.

"In conclusion, the long-term outcome of patients who have had successful PCI for stable angina or non-ST segment elevation acute coronary syndrome receiving contemporary treatments is better than was predicted at the start of this study," the authors said. They add that "these findings should be taken into account when considering the place of trimetazidine in clinical practice."

Keywords: ESC Congress, ESC20, Percutaneous Coronary Intervention, Angiography, Acute Coronary Syndrome, Angina, Stable

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