Effect of trimetazidine on the functional capacity of ischemic heart disease patients not suitable for revascularization: Meta-analysis of randomized controlled trials

Abstract

Objective: To explore the effect of adding trimetazidine to other anti-anginal drugs on the functional capacity of ischemic heart disease (IHD) patients not suitable for revascularization when compared to first-line antianginal drugs alone.

Methods: MEDLINE and EMBASE databases were searched for English-language peer-reviewed randomized controlled trials (RCTs) comparing trimetazidine with first-line antianginal drugs alone or with placebo in IHD patients not suitable for revascularization and were included in this review. Quality of studies were assessed using the Cochrane collaboration "risk of bias" tool.

Results: Six RCTs, three were crossover studies. A total of 312 participants were included in this review. Overall quality of studies was moderate. Two studies found improvement in the 6-minute walking test (6-MWT) [standardized mean differences (SMD) 1.75; 95% CI 1.35 to 2.14; p <0.001], and two trials found improvement in the Canadian cardiovascular society (CCS) grading of angina class (SMD -1.37; 95% CI -1.89 to -0.84) in the trimetazidine group. Three of the better-quality trials found no increase in total exercise duration (TED) (SMD 0.34; 95% CI -0.10 to 0.78; p < 0.13). Significant heterogeneity was identified among trials describing outcomes for the New York Heart Association (NYHA) functional classification and left ventricular ejection fraction (LVEF %).

Conclusion: Trimetazidine improve walking time and angina severity in IHD patients not suitable for revascularization. Due to the inconsistency of available evidence, RCTs targeting IHD patients with "no option" to undergo coronary revascularization is required to clarify this review question.

Fig 1. PRISMA 2009 flow diagram demonstrating the search and selection strategy.

PRISMA; Preferred Reporting Items for Systematic Reviews and Meta-Analysis.

Fig 2

Forest plots showing the SMDs for the parameters of patient’s functional capacity: 2a) New York heart association (NYHA) functional classification; 2b) total exercise duration (TED); 2c) six-minute walk test (6-MWT). CI confidence interval.

Fig 3

Forest plots showing the SMDs for the secondary parameters of: 3a) Canadian cardiovascular society (CCS) angina class; 3b) left ventricular ejection fraction (LVEF).