Trimetazidine as adjunctive therapy to primary PTCA for acute myocardial infarction

Acute myocardial infarction remains a complex medical problem despite major advances in its management, especially early myocardial reperfusion by percutaneous transluminal coronary angioplasty (PTCA). Situations such as absence of TIMI 3 flow grade and/or persistence of ST segment elevation despite successful PTCA, no-reflow phenomenon and absence of improvement of myocardial regional contractility despite angiographic TIMI 3 flow, probably involve microvascular injury due to neutrophil and platelet activation, free radical generation and myocardial metabolic disorders. Trimetazidine is a well tolerated and efficient antianginal agent, that experimentally reduces ischemia-reperfusion injuries, neutrophil infiltration, platelet aggregation and has antioxidant effects. The Limitation of Infarct Size by trimetazidine Trial (LIST) randomized 94 patients with acute myocardial infarction undergoing primary PTCA into two groups: placebo versus trimetazidine i.v. infusion started before PTCA and continued for 48 hours. Continuous ST segment monitoring was performed during and after primary PTCA. The major results of the study were a significantly more important and faster reduction of ST segment elevation with a trend to less ST segment exacerbation, in the trimetazidine group after PTCA compared to the placebo group. These results suggest that trimetazidine may efficiently reduce ischemia-reperfusion lesions after primary PTCA for acute myocardial infarction.