WITHDRAWN: Trimetazidine for stable angina.

Area of Science:

• Cardiology
• Pharmacology
• Internal Medicine

Background:

• Stable angina patients uncontrolled by monotherapy often require combination therapy, which can lead to adverse effects.
• Percutaneous transluminal coronary angioplasty is not accessible or affordable for many, especially in developing countries.
• Trimetazidine, an anti-anginal agent, offers a potential alternative by targeting intracellular metabolism.

Purpose of the Study:

• To evaluate the efficacy and tolerability of trimetazidine in patients diagnosed with stable angina.
• To compare trimetazidine's effectiveness against placebo and other anti-anginal medications.

Main Methods:

• A systematic review of randomized controlled trials was conducted, searching databases including Cochrane Central Register, MEDLINE, EMBASE, LILACS, and SCISEARCH up to October 2003.
• Twenty-three studies involving 1378 patients met the inclusion criteria for analysis.
• Data on angina attacks, nitroglycerin consumption, exercise tolerance, and adverse events were extracted and analyzed.

Main Results:

• Trimetazidine significantly reduced weekly angina attacks (mean difference -1.44) and nitroglycerin tablet consumption compared to placebo.
• Exercise duration until 1 mm ST segment depression improved significantly with trimetazidine treatment (P = 0.0002).
• Limited data suggest trimetazidine may have fewer dropouts due to adverse events compared to other anti-anginal agents.

Conclusions:

• Trimetazidine demonstrates efficacy in managing stable angina, showing benefits over placebo in reducing angina symptoms and improving exercise tolerance.
• The drug appears to be well-tolerated, with potentially fewer adverse events leading to treatment discontinuation.
• Further large-scale, long-term trials are necessary to definitively establish trimetazidine's role in clinical practice compared to existing therapies.