Purpose

Trimetazidine, a metabolic agent with anti-ischemic effects, was reported to reduce reperfusion injury in animal models. In this randomized double-blind placebo-controlled trial, we investigated the effects of trimetazidine on the reduction of infarction size in patients undergoing revascularization for ST segment elevation myocardial infarction (STEMI).

Methods

Patients with STEMI randomly received trimetazidine (n = 87) or placebo (n = 86) before primary percutaneous coronary intervention (PCI), and subsequently received oral trimetazidine or placebo for 12 months after reperfusion. The predefined primary endpoint was infarction size on cardiac magnetic resonance (CMR) performed at 7 days after primary PCI. The trial was registered on www.clinicaltrials.gov (registration number: NCT02826616).

Results

The clinical characteristics of the patients in both groups were well-matched at baseline. At 7 days after primary PCI, the percentage and absolute infarction size in the trimetazidine group were significantly smaller than those in the control group (22% ± 12% [n = 74] vs. 27% ± 13% [n = 74], p = 0.011 and 28 ± 18 g [n = 74] vs. 35 ± 19 g [n = 74], p = 0.022, respectively), and the incidence of myocardial microvascular obstruction (MVO) measured by CMR was significantly reduced in the trimetazidine group (29.7% [22/74] vs. 52.7% [39/74], p = 0.005). The myocardial salvage index (MSI) measured by CMR was significantly higher in the trimetazidine group (48% ± 20% vs. 39% ± 20%, p = 0.008). The incidence of readmission due to aggravated heart failure did not differ significantly between the trimetazidine group and the control group (8.0% vs. 14.0%, p = 0.234).

Conclusions

In patients with STEMI undergoing primary PCI, early trimetazidine before reperfusion reduced myocardial infarction size and MVO, and improved MSI.

中文翻译：

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接受直接经皮冠状动脉介入治疗治疗 ST 段抬高心肌梗死患者的早期曲美他嗪治疗可减少心肌梗死面积

目的

据报道，曲美他嗪是一种具有抗缺血作用的代谢剂，可减少动物模型的再灌注损伤。在这项随机双盲安慰剂对照试验中，我们研究了曲美他嗪对 ST 段抬高型心肌梗死 (STEMI) 血运重建患者减少梗死面积的影响。

方法

 STEMI 患者在直接经皮冠状动脉介入治疗 (PCI) 前随机接受曲美他嗪 ( n  = 87) 或安慰剂 ( n = 86)，随后在再灌注后接受口服曲美他嗪或安慰剂 12 个月。预定义的主要终点是直接 PCI 后 7 天进行的心脏磁共振 (CMR) 的梗死面积。该试验已在 www.clinicaltrials.gov 上注册（注册号：NCT02826616）。

结果

两组患者的临床特征在基线时匹配良好。直接 PCI 后 7 天，曲美他嗪组的百分比和绝对梗死面积明显小于对照组（22% ± 12% [ n  = 74] vs. 27% ± 13% [n = 74]，p  = 0.011 和 28 ± 18 g [n = 74] 对比 35 ± 19 g [n = 74]，p  = 0.022），并且通过 CMR 测量的心肌微血管阻塞 (MVO) 的发生率在曲美他嗪组（29.7% [22/74] 与 52.7% [39/74]，p  = 0.005）。通过 CMR 测量的心肌挽救指数 (MSI) 在曲美他嗪组中显着更高（48% ± 20% 对 39% ± 20%，p = 0.008）。曲美他嗪组和对照组因心力衰竭加重而再入院的发生率没有显着差异（8.0% 对 14.0%，p  = 0.234）。

结论

在接受直接 PCI 的 STEMI 患者中，再灌注前早期使用曲美他嗪可减少心肌梗死面积和 MVO，并改善 MSI。