ANTIANGINAL EFFICACY OF THE COMBINATION OF TRIMETAZIDINE-PROPRANOLOL COMPARED WITH ISOSORBIDE DINITRATE-PROPRANOLOL IN PATIENTS WITH STABLEANGINA

Trimetazidine is a new anti-ischaemic drug that exerts cytoprotective effects without modifying coronary blood flow or systemic haemodynamic s. We tested the antianginal efficacy of trimetazidine in combination with propranolol, using a double-blind isosorbide dinitrate-controlled design. Male patients (n = 53) with stable, effort-induced angina not sufficiently controlled with propranolol 40mg 3 times daily received at random either trimetazidine 20mg 3 times daily (n = 27) or isosorbi de dinitrate 10mg 3 times daily (n = 26) for 2 months. From day 0 to d ay 60, in both groups, there was a decrease in the average number of a nginal attacks per week (p < 0.01) and in the weekly consumption of ni troglycerin (p < 0.01), the latter being more decreased in the trimeta zidine group (p < 0.05). On exercise testing, both exercise duration a nd rime to I mm ST depression were improved in the trimetazidine group at day 60 compared with day 0 values (p < 0.001), while no significan t changes were observed in the isosorbide dinitrate group. The total w orkload increased significantly more in the trimetrtzidine group than in the isosorbide dinitrate group for patients performing the exercise test on a bicycle (n = 31, p < 0.001), but not on a treadmill (n = 22 , p = not significant). We concluded that in patients with stable indu ced angina not sufficiently controlled with propranolol, a better anti anginal efficacy was observed with the addition of trimetazidine than with the addition of isosorbide dinitrate, and this confirmed the clin ical interest in the new anti-ischaemic drug.