Role of Trimetazidine in Prevention of Coronary No Reflow in Patients with ST Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Abstract

BACKGROUND:
The efficacy of trimetazidine (TMZ) in chronic coronary syndrome has been well demonstrated butdata regarding
TMZ in managing acute myocardial infarction (AMI) remain unclear. So, in our study we aimed to evaluate the role
of TMZ in prevention of coronary no-reflow in STEMI patients undergoing primary Percutaneous Coronary
Intervention.
METHODS:
A Prospective observational open label case control study was conducted on 200 STEMI patients who underwent
PPCI. They were subdivided to 2 groups: Group I (control group): 100 patients who were not treated with TMZ.
Group II (TMZ group): 100 patients who were treated by trimetazidine before and after PPCI for 1 month. All
patients were assessed clinically, angiographically, ECG, Full labs and baseline echocardiography and after 1
month.
RESULTS:
There was a trend towards lower Incidence of coronary no reflow in the TMZ group (13%) as compared to the
control group (18%) however it did not reach statistical significance (P-value= 0.32). TMZ group showed highly
significant resolution of ST segment elevation in ECG after 24 hours as compared to the control group (P
value=0.002). The TMZ group also showed statistically significantly improvement of LV ejection fraction as
compared to the control group at 1 month follow up echocardiography (P-value=0.012).
CONCLUSIONSː
Although TMZ showed no significant improvement in TIMI flow in STEMI patients who underwent PPCI, however
it was associated with greater resolution of ST segment elevation on ECG and improvement of LV systolic function
(EF% and GLS by speckle tracking) after 1 month.