Evaluating the effect of trimetazidine for the treatment of patients with ischemic heart disease who are not suitable for revascularization.

This study evaluated the effectiveness of trimetazidine (Vastarel) versus other anti-anginal drugs for the treatment of patients with ischemic heart disease (IHD) who are not suitable for revascularization. The data showed that trimetazidine improved walking time and angina attacks in these patients.

Coronary artery disease (CAD) is a condition in which the blood vessels in the heart become blocked. This reduces the blood flow to the heart. Percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery are methods used to treat CAD by revascularization. Revascularization restores the delivery of the blood to the heart. PCI involves treating the narrowing of blood vessels using stents that keep the blood vessels open. CABG surgery involves attaching new blood vessels to the coronary arteries.

CAD can also cause stable angina (chest pain that occurs during physical activity) in many patients. These patients have limited revascularization options. Trimetazidine causes changes in the cells of the heart. This allows the heart to withstand reduced blood flow. Trimetazidine has been shown to reduce angina symptoms in people with stable angina. However, there are few studies evaluating the effectiveness of adding trimetazidine versus other anti-anginal drugs on the functional capacity of patients with IHD who are not suitable for revascularization.

This study analyzed 6 studies and involved 312 patients with IHD. The studies included compared trimetazidine with first-line antianginal drugs alone or with placebo in IHD patients not suitable for revascularization.

2 studies found that patients treated with trimetazidine significantly increased walking distance compared with the patients treated with placebo in the 6-minute walking test (6-MWT).  

3 studies found that total exercise duration (TED) was not significantly increased in patients who received trimetazidine compared to patients who received placebo.

2 studies found that trimetazidine significantly improved angina attacks in patients compared to placebo. 

This study concluded that trimetazidine improved walking time and angina attacks in patients with IHD not suitable for revascularization.

This study looked back in time at medical records. The sample size was very small. In some of the studies, the patients knew which treatment they were getting.