Trimetazidine's Anti-ischemic Effectiveness in Patients with Stable Angina with Prior Myocardial Infarction Evaluated via Stress Echocardiography with Speckle Tracking: METHOD study.

INTRODUCTION: Stress-test echocardiography with speckle tracking modality (STM) is sensitive to detect myocardial ischemia. Data on trimetazidine (TMZ) therapy's effectiveness on myocardial ischemia and contractile function using STM is limited. This study aimed to assess the anti-ischemic effectiveness of trimetazidine 80 mg once daily (TMZ OD) in patients with symptomatic stable coronary artery disease (CAD) with a history of myocardial infarction (MI), in real-world practice. METHODS: The METHOD study (NCT05210465) was a 6-month observational study evaluating TMZ OD's anti-ischemic and antianginal effectiveness in CAD patients with MI history using stress echocardiography with dobutamine and STM. Adult outpatients starting TMZ OD alongside standard antianginal therapy were included. The primary outcome was the mean change in left ventricular global longitudinal strain (LV GLS) after 6 months. Secondary outcomes were changes in regional peak systolic deformation (RPSD) and global post-systolic index, along with traditional antianginal effectiveness indicators and quality of life (QoL) using the EQ-5D-5L questionnaire. RESULTS: Thirty-six patients were included. TMZ OD significantly improved LV GLS by 2% (95% CI - 2.6 to - 1.5, p < 0.001). RPSD significant improvements were observed in 12/17 LV segments, ranging from - 2.6% to - 0.5%. Angina frequency and short-acting nitrate use decreased from 1.0 (1.4) to 0.1 (0.4) attacks per week and from 0.5 (1.0) to 0.1 (0.3) times per week, respectively (both p < 0.05). QoL improved significantly in mobility (1.8 [0.9] vs. 1.4 [0.7]), pain (2.0 [0.4] vs. 1.3 [0.5]) and anxiety domains (1.5 [0.7] vs. 1.2 [0.5]), (all p < 0.05). TMZ OD was well tolerated with no reported adverse events. CONCLUSIONS: This real-world study supports TMZ OD role as a valuable adjunct to standard antianginal therapy in outpatients with stable CAD and a history of MI. TRIAL REGISTRATION: ClinicalTrialsGov: The METHOD (NCT05210465).