A cohort study on the efficacy of Trimetazidine for acute myocardial infarction

Background: Acute coronary syndromes (ACS) account for nearly half of the deaths due to cardiovascular disease. Although case fatality rates are declining, it has continued to be the leading cause of mortality in the Philippines. Trimetazidine (TMZ) is a metabolic agent which directly improves myocardial energy metabolism resulting in cytoprotective effects during ischemia. This study aims to determine the efficacy of oral TMZ as adjunct to standard treatment in reducing in-patient mortality, incidence of arrhythmia and acute kidney injury (AKI) and length of hospital stay, in patient presenting with acute myocardial infarction.

Methods: This is a retrospective cohort study evaluating all adult patients admitted in the coronary care unit of St. Luke's Medical Center - Global City. Patients were divided into two groups: those treated with TMZ during their in-hospital management period and those who were not. Primary end-point was in-hospital mortality; secondary end-points were incidence of arrhythmia, AKI and length of ICU and hospital stay.

Results: Of the 67 patients included, 31 (46.2%) were given TMZ at 35mg orally twice daily. The two groups were matched with regard to baseline characteristics. During the study period, there was 1 (3.2%) and 3 (8.3%) mortality in the TMZ and control groups, respectively, with a relative risk of 0.39 (95% CI 0.57 to 4.61). More arrhythmias, mostly ventricular tachycardia, were seen in the TMZ group than with the control group with a relative risk of 1.63 (95% CI 0.57 to 4.61). There was also a higher incidence of AKI in the TMZ group with a relative risk of 1.49 (95% CI 0.63 to 3.54). No significant difference was seen in length of hospital and ICU stay.

Conclusion: Trimetazidine as adjunct to standard treatment for patients admitted for acute myocardial infarction appears to have no benefit in mortality and length of ICU and hospital stay.