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Hot Line: Trimetazidine fails to improve outcomes after successful revascularisation – results from the ATPCI trial

Despite antianginal therapy and successful percutaneous coronary intervention (PCI), angina typically recurs in 30% of patients and there are limited contemporary data on the benefits of antianginal drugs in post-PCI patients. Trimetazidine improves energy metabolism of the ischaemic myocardium, and investigators of the ATPCI trial aimed to establish whether trimetazidine could improve prognosis in patients with angina who had been treated with PCI.

Interventional Cardiology and Cardiovascular Surgery
Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care

Key findings from the ATPCI trial were described as a Hot Line at ESC Congress 2020 today by Principal Investigator, Professor Roberto Ferrari (University of Ferrara, Italy). This double-blind trial enrolled 6,007 patients who had undergone successful PCI, either elective for stable angina (n=3,490) or urgent for unstable angina or non-ST-elevation myocardial infarction (n=2,517). Patients were randomly assigned to receive either trimetazidine (modified release 35 mg twice daily) or placebo, both in addition to standard therapy.

The primary efficacy endpoint was the composite of cardiac death, hospitalisation for a cardiac event, or recurrent/persistent angina leading to adding, switching or increasing the dose of antianginal drugs or coronary angiography. After a median follow-up of 5 years, there was no difference between the groups in the rate of the primary efficacy endpoint: 700 (23.3%) patients in the trimetazidine group and 714 (23.7%) patients in the placebo group (p=0.7). There was also no difference between the groups in the rate of adverse events.

Prof. Ferrari concluded, “The trial shows that trimetazidine does not improve outcomes or symptoms after successful PCI in patients with acute and chronic coronary syndromes.”


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The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.