Evaluation of Trimetazidine in Angina Pectoris by Echocardiography and Radionuclide Angiography: A Meta-Analysis of Randomized, Controlled Trials

Background: The objective of this meta-analysis was to evaluate the efficacy of the metabolic agent trimetazidine(TMZ)as monotherapy in the treatment of stable angina pectoris, from echocardiography and radionuclide angiography data. Hypothesis: Treatment with TMZ proved to be as effective as other first-line antianginal agents for coronary patients, and it provided additional efficacy in combination with hemodynamic agents. Methods: A search of the literature published between 1965 and 2008 was performed on the MEDLINE and EMBASE databases. Only randomized, controlled trials were included in this meta-analysis. Patients had to be treated for at least 2 weeks with data on the following 4 parameters at baseline and at the end of the treatment period: left ventricular ejection fraction (LVEF), LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), and wall motion score index (WMSI). The quality of the trials was assessed by the Jadad score. Results: Eleven clinical studies meeting our criteria were analyzed. Results showed that TMZ significantly improved LVEF, with a mean increase of 6.88% (95% confidence interval [CI]: 5.50-8.25), and significantly reduced LVESV by 11.58 mL (95% CI: 5.79-17.37) and WMSI by 0.23 (95% CI: 0.07-0.38). Changes in LVEDV were variable. In both the long term and the short term, TMZ can improve LV function. The efficacy was unchanged in patients with diabetes mellitus. Conclusions: This meta-analysis confirmed the efficacy of TMZ monotherapy in improving LV function compared with placebo.