Trimetazidine effect on kidney function in patients undergoing coronary procedures

Area of Science:

• Cardiology
• Nephrology
• Pharmacology

Background:

• Contrast-induced nephropathy (CIN) is a risk following percutaneous coronary intervention (PCI) or coronary angiography (CA).
• Trimetazidine (TMZ) exhibits anti-ischemic, antioxidant, and mitochondrial protective effects, investigated for CIN prevention.
• Guidelines Directed Medical Therapy (GDMT) is standard care for patients undergoing coronary procedures.

Purpose of the Study:

• To evaluate the renoprotective effect of Trimetazidine (TMZ) when added to Guidelines Directed Medical Therapy (GDMT).
• To assess TMZ's impact on contrast-induced nephropathy (CIN) development and kidney function after coronary procedures.

Main Methods:

• A prospective observational cohort study involving 410 patients with Chronic Coronary Syndrome (CCS).
• Group I (205 patients) received GDMT plus TMZ; Group II (205 patients) received GDMT alone.
• Primary endpoint: CIN development at 72 hours. Secondary endpoint: Kidney function at one-month follow-up.

Main Results:

• CIN rates at 72 hours were 13.2% in the TMZ group vs. 22.0% in the control group (FDR-adjusted p=0.047).
• CIN rates at one month were 6.3% in the TMZ group vs. 13.2% in the control group (FDR-adjusted p=0.050).
• Results suggest a modest protective effect of TMZ, particularly for longer-term renal benefit.

Conclusions:

• Trimetazidine (TMZ) did not demonstrate robust protection against CIN at 72 hours in this cohort.
• TMZ may offer a modest, clinically relevant, longer-term renal benefit at one month post-procedure.
• Further randomized trials are necessary to confirm TMZ's efficacy and elucidate its mechanisms in CIN prevention.