Trimetazidine to reverse ischemia in patients with class I or II angina: a randomized, double-blind, placebo-controlled dobutamine-atropine stress echocardiography study.

Aims: We sought to evaluate the effects of trimetazidine on ischemia induced by dobutamine-atropine stress echocardiography in patients with class I or class II angina.

Methods: In a randomized, double-blind, placebo-controlled study, 66 patients with proved coronary disease were subjected to dobutamine-atropine stress echocardiography. Ischemia was proved in 56 patients who were included in the study and who had been on standard maintenance medications (propranolol, aspirin and statin). They were randomized to placebo or trimetazidine, 20 mg three times daily for a 12-week period, when dobutamine-atropine stress echocardiography was repeated.

Results: Fifty-two patients (56.53+/-8.9 years old) completed the study. No differences were seen between groups at entry. Thirty patients had class I and 26 class II angina. At the end of the study, 42 had class I and 14 class II angina (P=0.01), owing to patients being in the trimetazidine arm. We did not observe any differences between groups either for onset time of ventricular ischemic dysfunction, or for wall-motion score index. Comparing variation at peak using the delta wall-motion score index, we observed no differences, but only a trend toward reduction favoring trimetazidine (P=0.09).

Conclusion: We did not detect a significant anti-ischemic effect of trimetazidine in patients with mild angina, but there was a clear improvement in angina class.