Can we prevent myocardial and renal revascularization injury? Preventive effect of trimetazidine MR on myocardial and renal injury in diabetic patients with renal dysfunction undergoing elective PCI. PCI, percutaneous coronary intervention Shehata M. Am J Cardiol. 2014;114(3):

PCI is an effective treatment in AMI, but renal complications can occur INTRODUCTION Marenzi G. J Am Coll Cardiol. 2014;44: CIN (%) Risk score +1 to the risk score: Age >75 years Anterior acute myocardial infarction (AMI) Time-to-reperfusion >6 h Contrast agent volume >300 mL Use of intraaortic balloon pump Contrast-induced nephropathy (CIN) frequently complicates PCI, even in patients with normal renal function. It is associated with a higher in-hospital complication rate and mortality. Thus, preventive strategies are needed, particularly in high-risk patients.

 100 diabetic patients with stable angina and mild-to-moderate chronic kidney disease (CKD), about to undergo PCI.  Randomized into control group (n=50) and trimetazidine MR group (n=50) in which patients received trimetazidine 35 mg bid for 72 hours, starting 48 hours before PCI, on top of standard periprocedural therapy.  Blinded evaluation of two blood parameters:  Serum creatinine level pre-PCI, and at 72 hours and 10 days after PCI, reflecting the contrast-induced nephropathy.  Cardiac troponin I level before, and 6, 12, and 24 hours after PCI. Preventive effect of trimetazidine MR on post-PCI myocardial and renal injury METHODS Shehata M. - Am J Cardiol. 2014;114(3):

Serum creatinine (mg/mL) *P<0.05 vs control group RESULTS Preventive effect of trimetazidine MR on post-PCI myocardial and renal injury Results on the serum creatinine level Significant increase in the control group after PCI, meaning an increased risk of CIN. No significant change observed in the trimetazidine MR group, showing a preventive effect of trimetazidine MR against renal revascularization injury. Shehata M. Am J Cardiol. 2014;114(3):

Cardiac troponin I (pg/mL) Post-PCI time * P<0.001 vs control group * * * RESULTS Preventive effect of trimetazidine MR on post-PCI myocardial and renal injury Results on cardiac troponin level Trimetazidine MR treatment effectively reduces cardiac troponin I levels after PCI compared with the control group. Shehata M. Am J Cardiol. 2014;114(3):

DISCUSSION Preventive effect of trimetazidine MR on post-PCI myocardial and renal injury Shehata M. - Am J Cardiol. 2014;114(3):

PCI is an effective way to treat coronary stenosis in chronic heart disease; however, patients are prone to renal and myocardial ischemia-reperfusion injury, even in those not “at-risk.” Trimetazidine MR has been shown to effectively prevent CIN and myocardial injury in patients undergoing elective PCI, especially when they present high risks of chronic kidney disease and diabetes. The authors linked these results to the antioxidant activity and anti- ischemic efficacy of trimetazidine MR. CONCLUSION Preventive effect of trimetazidine MR on post-PCI myocardial and renal injury Shehata M. Am J Cardiol. 2014;114(3): These preliminary data need to be confirmed in a long-term large-scale randomized trial.