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Angina drug fails to improve outcomes after successful revascularisation

ATPCI trial presented in a Hot Line Session today at ESC Congress 2020

Cardiovascular Pharmacotherapy

Sophia Antipolis, France – 30 Aug 2020 :  Trimetazidine administered after successful percutaneous coronary intervention (PCI) does not improve outcomes in patients with chronic or acute coronary syndromes, according to results of the ATPCI trial presented in a Hot Line session today at ESC Congress 2020.1

Angina refers to constricting pain or discomfort in the front of the chest or in the neck, jaw, shoulder, or arm due to reduced blood flow to the heart. It can occur during acute coronary syndromes (ACS) and chronic coronary syndromes (CCS).

PCI improves prognosis in acute patients and can alleviate symptoms in chronic patients who do not respond to medication. However, previous studies have shown that angina recurs in 30% of patients despite antianginal therapy and successful PCI. There are limited contemporary data on the prognostic benefits of antianginal drugs in post-PCI patients.

The randomised ATPCI trial investigated the impact of trimetazidine added to standard therapy after PCI. Unlike typical angina medications, which improve blood flow by relaxing and widening the blood vessels, trimetazidine protects against myocardial ischaemia by improving the heart’s metabolism and favouring the use of glucose.

The 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 trimetazidine or placebo.

The primary efficacy endpoint was the composite of cardiac death; or 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 five years, the primary efficacy endpoint occurred in 700 (23.3%) patients in the trimetazidine group and 714 (23.7%) patients in the placebo group (p=0.7). There was no difference between groups in the rate of side effects.

Principal investigator Professor Roberto Ferrari of the University of Ferrara, Italy said: “The trial shows that trimetazidine does not improve outcomes or symptoms after successful PCI in patients with acute and chronic coronary syndromes.”


Notes to editor

Authors: ESC Press Office

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This press release accompanies both a presentation and an ESC press conference at ESC Congress 2020 – The Digital Experience. It does not necessarily reflect the opinion of the European Society of Cardiology.

Funding: Study supported by Servier.


Related to the ATPCI study:

R. Ferrari received fees, honoraria and travel expenses from Servier. He is the Director of Art Research and Science S.r.l (A.R.S.1).

Other honoraria/research grants/personal fees:

R. Ferrari received one of the above from AstraZeneca, Boehringer Ingelheim, Doc Generici, Lupin, Merck Serono, Novartis, Pfizer, Spa Prodotti Antibiotici, Sunpharma.

References and notes

1Abstract title: EfficAcy and safety of Trimetazidine in patients with angina pectoris having been treated by Percutaneous Coronary Intervention.

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