The Effectiveness of Preoperative Trimetazidine on Myocardial Preservation in Coronary Artery Bypass Graft Patients: A Systematic Review and Meta-Analysis

Abstract

Background: Coronary artery bypass grafting (CABG) is a key and effective surgical treatment modality for coronary artery disease. Unfortunately, ischemia-reperfusion injury during and after CABG can lead to reversible and irreversible myocardial damage. Trimetazidine [1-(2,3,4-trimethoxybenzyl)piperazine dihydrochloride] is a metabolic anti-ischemic agent with demonstrated cardioprotective effects; however, its effects with respect to myocardial preservation in CABG patients remain unclear. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to investigate the effectiveness of myocardial preservation of preoperative trimetazidine therapy in CABG patients by assessing the postoperative levels of several blood-based biochemical markers of myocardial injury, including creatine kinase (CK), creatine kinase-muscle and brain (CK-MB), creatine phosphokinase (CPK), troponin T (TnT) and troponin I (TnI). The RCTs were classified into two subgroup analyses by the timing of sample collection (either ≤12 or >12 h after CABG). Results: Six RCTs were finally included in the meta-analysis. The pooled effect sizes showed significantly lower postoperative levels of CK, CK-MB, TnT and TnI in the trimetazidine-treated CABG patients relative to control CABG patients. However, there were no significant differences in the postoperative CPK levels between trimetazidine-treated CABG patients relative to control CABG patients. In both the ≤12 and >12 h post-CABG subgroup analyses, significant differences in CK, CK-MB, TnT and TnI were detected between the trimetazidine-treated CABG patients relative to control CABG patients. Conclusions: Preoperative trimetazidine therapy appears to have a positive effect on myocardial preservation in CABG patients.

Efficacy of preoperative trimetazidine for preventing myocardial injury in patients undergoing off-pump coronary artery bypass grafting

“…Our findings about reducing the myocardial tissue injury with the usage of trimetazidine was supported by several studies which were consisted of patients undergoing on-pump conventional CABG [1,8]. Somewhat the cTnI levels in our study were higher than some previous reports, which may be related to different assay technology and kits used [2].…”

“…Trimetazidine has been shown to reduce myocardial injury during conventional CABG [1,[6][7][8]. Trimetazidine selectively inhibits the last enzyme (3-ketoacyl coenzyme A thiolase) participating in the betaoxidation of free fatty acids.…”

Myocardium Metabolism in Physiological and Pathophysiological States: Implications of Epicardial Adipose Tissue and Potential Therapeutic Targets

“…The main consequence is the shift from fatty acids metabolism into glucose utilization [189] and preserves the intracellular phosphocreatine and ATP ratio. This situation, as it was described before, is a protective mechanism against ischemia myocardial injury [190,191]. There is a reduction of resting energy expenditure, which is associated with the increment of catecholamines and growth hormone and the decrease of left ventricle function [192], all factors associated with heart failure.…”

Antiischemic Metabolic Modulator Trimetazidine in Treatment of Coronary Heart Disease

“…В естественных условиях было показано, что TACT [18] VASCO [20] ТМЗ может быть применен для кардиопротекции у пациентов, подвергающихся коронарной реваску-ляризации с помощью ЧКВ и АКШ [39,40], при не стабильной стенокардии [41]. Тем не менее, следует признать, что данные, основанные на жестких конеч-ных точках (показатели смертности), до сих пор отсутствуют.…”