Efficacy and Safety of Trimetazidine in Patients Having Been Treated by Percutaneous Coronary Intervention - ATPCI

Contribution To Literature:

The ATPCI trial failed to show that trimetazidine was superior to placebo at reducing adverse cardiovascular events.


Description:

The goal of the trial was to evaluate trimetazidine compared with placebo among patients with recent percutaneous coronary intervention (PCI). Trimetazidine is an antianginal agent that improves energy metabolism of ischemic myocardium.


Study Design

  • Randomized
  • Parallel
  • Placebo
  • Double-blind

Eligible patients were randomized to trimetazidine 35 mg twice daily (n = 2,998) versus placebo (n = 3,009).

  • Total number of enrollees: 6,007
  • Duration of follow-up: 47.5 months
  • Mean patient age: 60.9 years
  • Percentage female: 23%

Inclusion criteria:

  • 21-85 years of age
  • PCI for stable or unstable coronary artery disease (unstable angina or non-ST-segment elevation myocardial infarction) within the last 30 days

Principal Findings:

The primary outcome, cardiovascular death, hospitalization for cardiac events, recurrent/persistent angina leading to adding, switching, or increasing antianginal therapy, or coronary angiography occurred in 23.3% of the trimetazidine group compared with 23.7% of the placebo group (p = 0.73). There was no difference in the primary outcome according to elective or urgent PCI.

Secondary outcomes:

  • Angina requiring hospitalization: 17.9% in the trimetazidine group vs. 17.1% in the placebo group (p = nonsignificant)
  • Serious treatment-emergent adverse event: 40.9% in the trimetazidine group vs. 41.1% in the placebo group (p = nonsignificant)

Interpretation:

Among patients with recent PCI, trimetazidine was not superior to placebo at reducing adverse cardiovascular events. The event rate in this trial was lower than expected and may have contributed to the null finding.

References:

Ferrari R, Ford I, Fox K, et al., on behalf of the ATPCI Investigators. Efficacy and safety of trimetazidine after percutaneouscoronary intervention (ATPCI): a randomised, double-blind, placebo-controlled trial. Lancet 2020;396:830-8.

Presented by Dr. Roberto Ferrari at the European Society of Cardiology Virtual Congress, August 30, 2020.

Keywords: ESC Congress, ESC20, Angina, Stable, Angina, Unstable, Coronary Artery Disease, Coronary Angiography, Myocardial Infarction, Myocardial Ischemia, Percutaneous Coronary Intervention, Secondary Prevention, Trimetazidine


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