Efficacy and Safety of Trimetazidine for Stable Angina Pectoris: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

HE Chunhui ¹ ,  MA Yitong ¹ , SU Ran ² , YU Zixiang ¹ , WANG Xiaojun ³

1. Cardiology Department (Coronary Disease Section), the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;2. Department of Rheumatology and Immunology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;3. Endocrinology Department, Central Hospital of Chengde City, Chengde 067000, China;

Corresponding author：

MA Yitong, Email: myt-xj@163.com

Keywords：

Trimetazidine; Stable angina pectoris; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.20120114

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Objective To evaluate the efficacy and safety of trimetazidine (TMZ) in the treatment of Stable Angina Pectoris (SAP).
Methods Randomized controlled trials (RCTs) on the efficacy and safety of Trimetazidine in treating patients with SAP were retrieved in the following databases as CNKI (1997 to June 2011), WanFang Data (1989 to June 2011), MEDLINE (1966 to June 2011), EMbase (1974 to June 2011), CBM (1989 to June 2011) and Cochrane Central Database (1989 to June 2011). The literature which met the inclusion and exclusion criteria were selected, data were extracted, the quality was evaluated, and meta-analysis was performed by using RevMan 5.0 software.
Results A total of 15 RCTs involving 1 500 patients were included. The meta-analysis showed that, compared with the control group, TMZ was significantly superior in the following 5 aspects: the time to 1 mm drop of ST segment (WMD=0.84, 95%CI 0.74 to 0.93, P=0.000 01), duration of doing exercise (WMD=0.82, 95%CI 0.73 to 0.91, P=0.000 01), and time to onset of angina (WMD=1.18, 95%CI 0.87 to 1.50, P lt;0.000 01) in the treadmill test, weekly mean number of angina attacks (WMD= –1.79, 95%CI –1.93 to –1.66, P lt;0.000 01), and weekly side effects between TMZ and the control group (RR=0.83, 95%CI 0.52 to 1.32, P=0.42).
Conclusion Based on current studies, TMZ is superior to other medicines in the control group for SAP at present, and it has no significant difference in side effects compared with the control group, so it is regarded as an effective and safe drug. For the quality restrictions and possible publication bias of the included studies, this conclusion needs to be confirmed by more high quality, large sample, multi-center, double blind RCTs.

Citation： HE Chunhui,MA Yitong,SU Ran,YU Zixiang,WANG Xiaojun. Efficacy and Safety of Trimetazidine for Stable Angina Pectoris: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2012, 12(6): 700-707. doi: 10.7507/1672-2531.20120114 Copy

1.	Kantor P F, Lucien A, Kozak R, et al. The antianginal drug trimetazidine shifts cardiac energy metabolism from fatty acid oxidation to glucose oxidation by inhibiting mitochondrial long chain 3 ketoacyl coenzyme a thiolase. Circ Res, 2000, 86: 580-588.
2.	Mc Clelian KJ, Plosker GL. Trimetazidine: A review of itsuse in stable angina pectoris and other coronary condition. Drugs, 1999, 58(1): 143-157.
3.	Desideri A, Celegon L. Metabolic management of ischemic heart disease: clinical data with trimetazidine. Am J Cardiol, 1998, 82(5): 50-53.
4.	Cross H R.Trimetazidine for stable angina pectoris. Expert Opin Pharmacother, 2001, (5): 857-875.
5.	Austen WG, Edwards JE, Frye RL, et al. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation, 1975, 51(4Suppl): 5-40.
6.	Jadad AR, Moore RA, Corral D. Assessing the qaulity of the reports of randomized clinical trials :is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
7.	Sergio DV, Giuseppe M, Patricia DV, et al. Comparison of Trimetazidine with Nifedipine in Effort Angina:A Double-Blind, Crossover Study. Cardiovascular Drugs and Therapy, 1990, 4: 853-860.
8.	Andreas PM, Konstantinos S, Konstantinos D, et al. Antianginal Efficacy of the Combination of Trimetazidine-Propranolol Compared with Isosorbide Dinatrate-Propranolol in Patients with Stable Angina. Clin Drug Invest, 1997, 1, 13(1): 8-14.
9.	Philippe S, Jean PB. Assessment of Anti-Ischemic and Antianginal Effect at Trough Plasma Concentration and Safety of Trimetazidine MR 35mg in Patients with Stable Angina Pectoris, A multicenter, double blind, placebo controlled study. Am J Cardiovasc Drugs, 2003, 3(5): 361-369.
10.	许嘉鸿, 罗明, 邓兵, 等. 曲美他嗪治疗稳定型心绞痛的疗效和耐受性. 同济大学学报（医学版）, 2003, 24(6): 492-493.
11.	Nevres K, Ahmet K B, Kamil A, et al. Comparison of the effects of trimetazidine and diltiazem on exercise performance in patients with coronary heart disease. The Turkish trimetazidine study (TTS). Acta Cardiol, 2004, 12; 59(6): 644-650.
12.	Ruzyllo W, Szwed H, Sadowski Z, et al. Efficacy of trimetazidine in patients with recurrent angina: a subgroup analysis of the TRIMPOL II study. Current Medical Research and Opinion, 2004, 20(9): 1447-1454.
13.	Hanna S. Clinical benefits of trimetazidine in patients with recurrent angina. Coronary Artery Disease, 2004, 15 (S1): S17-21.
14.	童延清, 李晖. 曲美他嗪治疗稳定型心绞痛的临床研究. 心肺血管病杂志, 2004, 23(1):40.
15.	郑育平, 谢彤. 曲美他嗪治疗慢性肾衰竭合并冠心病稳定型心绞痛的临床疗效. 中国药师, 2004, 7(5): 371-372.
16.	Chazov EI, Lepakchin VK, Zharova EA, et al. Trimetazidine in Angina Combination Therapy-The TACT Study:Trimetazidine versus Conventional Treatment in Patients with Stable Angina Pectoris in a Randomized, Placebo-Controlled, Multicenter Study. American Journal of Therapeutics, 2005, 12(1): 35-42.
17.	周英, 李艳. 曲美他嗪在老年稳定性心绞痛中的作用.吉林医学, 2005, 26(10): 1061-1062.
18.	庞红, 林华, 张金枝. 曲美他嗪治疗稳定型劳力性心绞痛的对照观察.中国医院药学杂志, 2005, 25(12): 1158-1159.
19.	王伯忠, 王雁. 曲美他嗪与辅酶Q10治疗老年慢性稳定型心绞痛的临床观察.心脑血管病防治, 2006, 6(2): 103-105.
20.	张刚, 曹雪滨, 崔英凯,等. 曲美他嗪和倍他乐克联合应用治疗稳定型心绞痛的临床研究.现代中西医结合杂志, 2006, 15(21): 2926-2927.
21.	郑云. 曲美他嗪治疗稳定型心绞痛50例疗效观察. 临床医学, 2010, 23(6): 1858-1859.

1. Kantor P F, Lucien A, Kozak R, et al. The antianginal drug trimetazidine shifts cardiac energy metabolism from fatty acid oxidation to glucose oxidation by inhibiting mitochondrial long chain 3 ketoacyl coenzyme a thiolase. Circ Res, 2000, 86: 580-588.
2. Mc Clelian KJ, Plosker GL. Trimetazidine: A review of itsuse in stable angina pectoris and other coronary condition. Drugs, 1999, 58(1): 143-157.
3. Desideri A, Celegon L. Metabolic management of ischemic heart disease: clinical data with trimetazidine. Am J Cardiol, 1998, 82(5): 50-53.
4. Cross H R.Trimetazidine for stable angina pectoris. Expert Opin Pharmacother, 2001, (5): 857-875.
5. Austen WG, Edwards JE, Frye RL, et al. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation, 1975, 51(4Suppl): 5-40.
6. Jadad AR, Moore RA, Corral D. Assessing the qaulity of the reports of randomized clinical trials :is blinding necessary? Control Clin Trials, 1996, 17(1): 1-12.
7. Sergio DV, Giuseppe M, Patricia DV, et al. Comparison of Trimetazidine with Nifedipine in Effort Angina:A Double-Blind, Crossover Study. Cardiovascular Drugs and Therapy, 1990, 4: 853-860.
8. Andreas PM, Konstantinos S, Konstantinos D, et al. Antianginal Efficacy of the Combination of Trimetazidine-Propranolol Compared with Isosorbide Dinatrate-Propranolol in Patients with Stable Angina. Clin Drug Invest, 1997, 1, 13(1): 8-14.
9. Philippe S, Jean PB. Assessment of Anti-Ischemic and Antianginal Effect at Trough Plasma Concentration and Safety of Trimetazidine MR 35mg in Patients with Stable Angina Pectoris, A multicenter, double blind, placebo controlled study. Am J Cardiovasc Drugs, 2003, 3(5): 361-369.
10. 许嘉鸿, 罗明, 邓兵, 等. 曲美他嗪治疗稳定型心绞痛的疗效和耐受性. 同济大学学报（医学版）, 2003, 24(6): 492-493.
11. Nevres K, Ahmet K B, Kamil A, et al. Comparison of the effects of trimetazidine and diltiazem on exercise performance in patients with coronary heart disease. The Turkish trimetazidine study (TTS). Acta Cardiol, 2004, 12; 59(6): 644-650.
12. Ruzyllo W, Szwed H, Sadowski Z, et al. Efficacy of trimetazidine in patients with recurrent angina: a subgroup analysis of the TRIMPOL II study. Current Medical Research and Opinion, 2004, 20(9): 1447-1454.
13. Hanna S. Clinical benefits of trimetazidine in patients with recurrent angina. Coronary Artery Disease, 2004, 15 (S1): S17-21.
14. 童延清, 李晖. 曲美他嗪治疗稳定型心绞痛的临床研究. 心肺血管病杂志, 2004, 23(1):40.
15. 郑育平, 谢彤. 曲美他嗪治疗慢性肾衰竭合并冠心病稳定型心绞痛的临床疗效. 中国药师, 2004, 7(5): 371-372.
16. Chazov EI, Lepakchin VK, Zharova EA, et al. Trimetazidine in Angina Combination Therapy-The TACT Study:Trimetazidine versus Conventional Treatment in Patients with Stable Angina Pectoris in a Randomized, Placebo-Controlled, Multicenter Study. American Journal of Therapeutics, 2005, 12(1): 35-42.
17. 周英, 李艳. 曲美他嗪在老年稳定性心绞痛中的作用.吉林医学, 2005, 26(10): 1061-1062.
18. 庞红, 林华, 张金枝. 曲美他嗪治疗稳定型劳力性心绞痛的对照观察.中国医院药学杂志, 2005, 25(12): 1158-1159.
19. 王伯忠, 王雁. 曲美他嗪与辅酶Q10治疗老年慢性稳定型心绞痛的临床观察.心脑血管病防治, 2006, 6(2): 103-105.
20. 张刚, 曹雪滨, 崔英凯,等. 曲美他嗪和倍他乐克联合应用治疗稳定型心绞痛的临床研究.现代中西医结合杂志, 2006, 15(21): 2926-2927.
21. 郑云. 曲美他嗪治疗稳定型心绞痛50例疗效观察. 临床医学, 2010, 23(6): 1858-1859.

Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of Trimetazidine for Stable Angina Pectoris: A Systematic Review

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