Efficacy and tolerance of trimetazidine in combination with a conventionalantianginal drug in patients with stable angina

OBJECTIVE: Assess the antianginal and anti-ischemic effect of trimetazidine in patients with stable exercise-induced angina insufficiently controlled with conventional antianginal drugs. PATIENTS AND METHODS: The study population included patients with coronarog raphically documented stable exercise-induced angina and no other serious c oncomitant condition. For inclusion, patients had to have two comparably po sitive treadmill exercise tests. Conventional antiangina drugs (long-acting nitrate derivatives, beta-blockers or calcium antagonists) were continued as was any other therapy having no effect on the ECC ST segment The patient s were given a 4-week regimen of trimetazidine (20 mg t.i.d.) after the sec ond positive treadmill test and final inclusion. At the end of this period, a final exercise test was performed. The study population included 700 pat ients (mean age 54 +/- 8.4 years, range 32 - 71 years, 615 men, 85 women) w ho completed the entire treatment protocol. RESULTS: The main findings observed after 4 weeks of treatment with trimeta zidine were: significant lengthening of the total duration of exercise (486 .6 s venus 443.7 s, p < 0.01)), increase in total work (10.6 METS versus 9. 4 METS, p < 0.01), significant lengthening of delay to 1 mm ST depression ( 389.9 s versus 337.8 s, p < 0.01) and of the delay to onset of angina (450. 3 s venus 251.7 s, p < 0.01). The other results were a significant reductio n in the number of daily episodes of angina (2.47 venus 3.66, p < 0.01) and a reduction in mean use of complementary trinitrine (1.8 versus 2.94, p < 0.01). CONCLUSIONS: Four weeks of treatment with trimetazidine in combination with conventional antiangina drugs leads to a longer delay to development of 1 mm ST depression (ischemia threshold), significant lengthening of total dur ation of treadmill exercise, increased total work, and longer delay to angi na threshold. Clinically there was a reduction in the mean number of episod es of angina and a reduction in the use of trinitrine.