Nr. 11(2)/2008

Elena Bobescu, Mariana Rădoi, Georgeta Datcu, Zoltan Galajda, Antoniu Burducea, Carmen-Daniela Neculoiu, Roxana Bârsăşteanu, Dorina Popa, Valeria Paler, Mariana Anghel

The aim of this clinical study was to evaluate the efficacy of treatment with trimetazidine modified release (MR) in addition to optimal standard medical therapy in patients with coronary heart disease - stable angina, unstable angina and non ST elevation myocardial infarction in inflammatory syndrome and oxidative stress reduction in concordance with recovery of ECG and echocardiographic changes. Design: 252 patients were included in a prospective study for a period of 3 years and separated in six groups in relation with type of coronary heart disease and addition of trimetazidine MR to optimal standard medical therapy. Clinic, electrocardiographic and echocardiographic evaluation were performed initial, at 1, 6 months, 1, 2 and 3 years and biologic, evaluation initial, at 1 and 6 months. Anti ox-LDL antibody titers and total antioxidant status serum level were measured for oxidative stress evaluation, C-reactive protein serum level and fibrinogen plasma level were evaluated as markers of inflammatory syndrome. Results: A significant reduction in oxidative stress in terms of incidence of low total antioxidant status serum level at 1, 6 months, incidence of high anti ox-LDL antibody serum titers at 6 months and a significant reduction in inflammatory syndromes in terms of high C-reactive protein serum level and high fibrinogen plasma values at 6 months of follow up were observed in patients with unstable angina and non ST elevation myocardial infarction treated with trimetazidine added to optimal standard medical therapy. This results were in concordance with significant reduction in incidence of ST depression on ECG at 1, 6 months, 1, 2 and 3 years and with significant improvement in echocardiographic measured left ventricular ejection fraction at 2 and 3 years in mentioned groups of patients. Global wall motion score index at 1, 2 and 3 years was significantly improved in all trimetazidine treated groups. Conclusions: Selective inhibition of long chain 3-ketoacyl-Coenzyme-A-thiolase by Trimetazidine MR was followed by a significant reduction in inflammatory syndromes and oxidative stress at 6 months of follow up in patients with unstable angina and non ST elevation myocardial infarction. These results were in concordance with significant reduction in incidence of ST depression on ECG and significant improvement in echocardiographic measured left ventricular function at 3 years of follow up.

Keywords: coronary heart disease,trimetazidine MR,oxidative stress,inflammatory syndrome,ST segment depression,left ventricular function