EFFICACY OF TRIMETAZIDINE IN PATIENTS WITH ACUTE CORONARY SYNDROMES AND CO-MORBIDITIES
Acute coronary syndrome (ACS) is a serious clinical manifestation of coronary artery disease and is the major cause of morbidity and mortality worldwide. Established, that ACS and sudden death cause most IHD-related deaths, which represent 1.8 million deaths per year, with similar numbers of men and women dying from CAD. It is estimated that nearly half of patients with acute coronary syndrome (ACS) have one or more comorbid conditions, which have been linked to poor prognosis. The complexity of clinical decision-making in the presence of multiple comorbidities and the lack of explicit guidelines has been linked to poorer adherence to treatment protocols and worse outcomes for ACS patients. Under-usage of medication and standard-of-care procedures due to the unknown effects of certain therapies for patients with multiple comorbidities (e.g. percutaneous coronary interventions, dual antiplatelet therapy) and worse in-hospital and one year outcomes as well as increased mortality rates have been reported in ACS patients with multiple co-morbidites.
Trimetazidine is a second-line medication for treatment stable angina and microvascular angina in European and national guidelines. The efficacy and safety of trimetazidine in ACS patients are under investigation.
The purpose of research: to assess the short-term potential benefits and safety of trimetazidine added to standard evidence-based medical treatment in patients with ACS and co-morbidities: arterial hypertension and/or 2 type diabetes mellitus.
Material and Methods. We observed of 184 patients with ACS with arterial hypertension (AH) and / or 2 type diabetes (DM). The diagnosis was verified by laboratory and instrumental methods according to European Society of Cardiology guidelines (2017, 2020) [10, 11]. All patients were divided into four groups: 1st group - 42 patients with ACS without AH or DM; 2nd group – 56 patients with ACS and previous AH; 3rd group – 42 patients with ACS and 2 type DM; and 4th group – 44 patients with ACS and AH and DM. Due to the treatment strategy patients from each group were divided into 2 subgroups: a – with guidelines-recommended therapy (GRT) and b – with GRT and trimetazidine (TMZ) 35 mg twice a day. The following laboratory tests were performed, in our trial: blood glucose, HbA1c, serum urea, serum creatinine, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, triglyceride, serum sodium, serum potassium, CRP, cardiac troponin I, NT-proBNP.
Results. The mean age of all observed patients with ACS was 64.6±11.9 years; 93 (50.5%) were males and 91 (49.5%) females among them (see table 1). ACS without persistent ST segment elevation was diagnosed in 44 (23.9%) cases; instead ACS with persistent ST segment elevation – in 140 (76.1%) cases. In all trimetazidine treatment groups, the weekly frequency of angina symptoms showed the significant reductions at 28-day visit compared with baseline (p<0.05). Similar, the short-acting nitrate consumption was significant low during the course of treatment with trimetazidine (p<0.05). Additional prescription of trimetazidine had significant effects for decrease of glucose, LDL cholesterol, CRP and NT-proBNP levels in patients with ACS and co-morbidities. Any serious adverse events were detected in the trimetazidine groups or in the placebo groups.
Conclusions. Additional prescription of trimetazidine has significant effects for decrease of glucose, LDL cholesterol, CRP and NT-proBNP levels in patients with ACS and arterial hypertension and/or 2 type diabetes mellitus and has good safety.
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