Comparison of the efficacy of trimetazidine in revascularized and non-revascularized stable angina patients based on the ONECAPS study

Osszefoglalo. Bevezetes: A kozelmultban publikalt ATPCI-vizsgalat azt eredmenyezte, hogy kozvetlenul a sikeres revaszkularizacio utan alkalmazott trimetazidin biztonsagos volt, de nem volt effektivebb a cardiovascularis halal, anginarekurrencia, cardialis hospitalizacio tekinteteben, mint a random kettős vakmodszerrel alkalmazott placebo. Celkitűzes: Az altalunk korabban vegzett ONECAPS nyitott, obszervacios vizsgalat retrospektiv analiziset kivantuk elvegezni annak eldontesere, hogy az anginas betegeknel van-e kulonbseg a trimetazidin prolong hatasossagaban annak megfelelően, hogy korabban revaszkularizacio tortent. Modszer: 1670, anginas betegből 1008 nem volt revaszkularizalva, mig 662 korabban revaszkularizacion esett at. Az eletkorban, tarsbetegsegben nem volt kulonbseg a ket csoport kozott. A betegeknel a heti anginaszamnak es a nitroglicerin-fogyasztasnak, illetve az angina sulyossaganak a valtozasat vizsgaltuk a trimetazidin prolong 80 mg napi egyszeri alkalmazasa soran a revaszkularizalt es a nem revaszkularizalt betegcsoportban. Eredmenyek: Mind a revaszkularizalt, mind a nem revaszkularizalt betegcsoportban szignifikans csokkenest (p<0,0001) eredmenyezett a trimetazidin mind a heti anginaszamban, mind a rovid hatasu nitroglicerin fogyasztasaban. Emellett mindket betegcsoportban novekedett a Kanadai Cardiovascularis Tarsasag (CCS) osztalyozasa szerinti I. sulyossagu angina aranya, es csokkent a CCS III., illetve CCS IV . aranya is. Mindezt a hatast ugy ertek el, hogy a revaszkularizalt betegeknel 90% felett volt a sztatin, az ACEI/ARB, illetve a beta-blokkolo hasznalata. Kovetkeztetes: A trimetazidin prolong napi egyszeri 80 mg adasa szignifikansan csokkenti a heti anginaszamot, nitroglicerin-fogyasztast, illetve az angina sulyossagat. Ezen hatasa fuggetlen attol, hogy a beteg korabban reszesult-e revaszkularizacioban vagy sem. Orv Hetil. 2021; 162(29): 1167-1171. SUMMARY INTRODUCTION The recently published ATPCI study resulted in the safety of trimetazidine administered immediately after successful revascularization but was not more effective (cardiovascularis death, recurrence of angina, hospitalization for cardiac event) than the randomized double-blind placebo. OBJECTIVE A retrospective analysis of our previously published ONECAPS open-label observational study was performed to determine whether there was a difference in the efficacy of trimetazidin prolong in the angina patients according to whether or not they had previously undergone revascularization. METHOD Of the 1670 angina patients, 1008 were not revascularized, while 662 had previously undergone revascularization. There was no difference in age or comorbidity between the two groups. Patients were examined for changes in weekly angina, short-acting nitroglycerin use and angina severity during once-daily administration of trimetazidine prolong 80 mg in revascularized and non-revascularized study groups. RESULTS In both the revascularized and non-revascularized group, trimetazidine resulted in a significant reduction (p<0.0001) in both weekly angina count and short-acting nitroglycerin use. In addition, the proportion of angina with Canadian Cardiovascular Society (CCS) I increased and the proportion of CCS III and CCS IV decreased in both patient groups as well. All of this effect was achieved with statin, ACEI/ARB, and beta-blocker use above 90% in revascularized patients. CONCLUSION Trimetazidine prolong 80 mg once daily significantly reduced the number of angina per week, the use of short-acting nitroglycerin per week, and the severity of angina. This effect is independent of whether the patient has previously received revascularization. Orv Hetil. 2021; 162(29): 1167-1171.