Transcript the slide set

Can we prevent stent restenosis
after coronary stent implantation?
Benefits of trimetazidine
on the incidence of stent restenosis
after percutaneous coronary intervention.
Chen J et al. Int J Cardiol. 2014;173(3):597-600.
Preventive effect of trimetazidine
on post-PCI restenosis
INTRODUCTION
 In previous studies, pretreatment with trimetazidine has been shown to
prevent myocardial injury during percutaneous coronary intervention.1
 Trimetazidine has also been shown to reduce recurrent angina, and to
preserve left ventricular function after PCI.2
 Despite successful PCI, and despite the introduction of a drug-eluting
stent (DES), patients are still highly prone to restenosis.3
 The present study investigates whether trimetazidine could also have a
beneficial effect on the occurrence and progression of stent restenosis.
1. Bonello L et al. Heart. 2007;93:703-707.
2. Xu X et al. Clin Drug Investig 2014;34:251–258.
3. Chen J et al. Int J Cardiol. (2014) 2014;173(3):597-600.
Preventive effect of trimetazidine
on post-PCI restenosis
METHODOLOGY
 768 patients undergoing PCI for the first time randomized into the
trimetazidine group (n=384) and control group (n=384).
 After DES implantation, all patients were treated with regular
medication.
 In the trimetazidine group, trimetazidine was administrated at 20 mg
tid* for at least 30 days.
 All patients received blinded follow-up angiography 9 to 13 months after
discharge.
Primary end point:
 Restenosis
Secondary end point:
 Major adverse cardiac and cerebrovascular events (MACCEs).
Chen J et al. Int J Cardiol. 2014;173(3):597-600.
*Trimetazidine 20 mg tid is equivalent to trimetazidine 35 mg bid.
Preventive effect of trimetazidine
on post-PCI restenosis
RESULTS
Results on restenosis
The trimetazidine group has a lower incidence of stent restenosis compared with the control
group (4.2% vs 11.1%; P=0.001).
% of events
P=0.001
11.1
4.2
Chen J et al. Int J Cardiol. 2014;173(3):597-600.
Preventive effect of trimetazidine
on post-PCI restenosis
RESULTS
Results on restenosis and the number of MACCEs
The incidence of MACCEs is also significantly decreased in the trimetazidine treatment group at
the 1-year follow-up visit (6.1% vs 10.8%; P=0.034).
MACCEs include: death from any cause, nonfatal myocardial infarction, revascularization stroke, and cerebral bleeding.
Chen J et al. Int J Cardiol. 2014;173(3):597-600.
Preventive effect of trimetazidine
on post-PCI restenosis
RESULTS
Results on predictors for stent restenosis
Several predictors for stent restenosis have been identified. Among these predictors,
diabetes mellitus, current smoking, stent diameter and length, and age have been shown to
stimulate restenosis, while trimetazidine has been shown to prevent restenosis.
Trimetazidine:
a predictor of protection
Chen J et al. Int J Cardiol. 2014;173(3):597-600.
Preventive effect of trimetazidine
on post-PCI restenosis
CONCLUSION
 Even after successful PCI with DES, patients need to be better protected
against restenosis.
 Trimetazidine seems to be protective against stent restenosis in angina
patients who undergo PCI. Trimetazidine also may effectively prevent the
occurrence of MACCEs.
 Myocardial injury prevention during PCI and reduction of post-PCI angina
symptoms persistence have been observed with trimetazidine
 All these results suggest that trimetazidine should be combined early in
the management of ischemic patients to protect their heart, especially
when they undergo PCI.
Chen J et al. Int J Cardiol. 2014;173(3):597-600.