Trimetazidine as Adjunctive Therapy for Decreasing Major Adverse Cardiac Events in Coronary Artery Disease Patients Undergoing Reperfusion Strategy: A Meta-analysis of Randomized Controlled Trials

Abstract

Trimetazidine as adjunctive therapy in cardioischemic patients has shown improvement in angina and left ventricular ejection fraction, but with conflicting evidence on hard clinical outcomes. This  meta-analysis aims to compare the efficacy of trimetazidine versus placebo in reducing cardiac   mortality and major adverse cardiac events (MACEs) in coronary artery disease patients after reperfusion strategies, whether percutaneous coronary intervention or thrombolysis. The primary outcomes examined were cardiac mortality and combined MACEs; secondary outcomes were repeat revascularization, heart failure after reperfusion, stent restenosis, recurrence of angina, and reinfarction. Trimetazidine in comparison to placebo was associated with lower cardiac mortality and combined MACEs, but results were not significant. Among secondary outcomes, only stent restenosis was significantly reduced (risk ratio, 0.53; 95% confidence interval, 0.34–0.83; P = 0.006). Further trials should be conducted with more standard dosing regimens, duration of therapy, and similar severities of ischemic disease.