Effects of trimetazidine administration before thrombolysis in patients with anterior myocardial infarction: Short-term and long-term results

Reperfusion may prevent or reduce the development and extent of necrosis, b ut may also lead to an increase in reperfusion damage. Experimental studies performed in various animal models of myocardial ischemia have demonstrate d the anti-ischemic properties of trimetazidine (TMZ) and have suggested th at TMZ has antioxidant properties, without any direct hemodynamic effects. Our study was aimed at investigating the effects of TMZ before thrombolysis in acute anterior myocardial infarction and included 81 patients, hospital ized within 4 hours of the onset of symptoms. Patients were randomly (doubl e-blind) subdivided in two groups The first group (40 patients, Group A, TM Z-pretreatment), received 40 mg TMZ orally about 15 minute before thromboly sis and, subsequently, 20 mg every 8 hours. The second group (41 patients, Group B) received placebo before thrombolysis. Ventricular arrhythmias (VA) due to reperfusion were evaluated in the first 2 hours. VA occurred in 15 of patients in group A, versus 29 in group B, p < 0.05. Creatine kinase (CK ) normalization time was achieved after 55.7 +/- 12.5 hours in group A, ver sus 61.2 +/- 12.1 hour in group B, p = 0.048. CK peak was 1772 +/- 890 in g roup A vs 2285 +/- 910 UI/l in group B, (p = 0.012). In the follow-up (rang e 6-22 months), there were 4 deaths, two patients in each group. After 180 days from treatment, the TMZ group showed a smaller end systolic volume tha n the placebo group (echocardiographic data), 46.2 +/- 12 and 52.8 +/- 13 m l/m(2), respectively, p = 0.037. Our data suggest that TMZ probably reduces reperfusion damage and/or infarct size in patients with anterior AMI subje cted to thrombolysis and affects the post-AMI remodeling. Our data must be interpreted with caution because of the selection of patients. These findin gs require further extensive trials.