Key result
Preoperative trimetazidine reduces 12-hour post-surgery cTnI levels by ~50% versus placebo.
Why the study?
There is a risk of ischemic myocardial injury during off-pump CABG due to normothermic and metabolically active myocardium during coronary artery occlusion, and the efficacy of trimetazidine in preventing this injury was evaluated.
Does preoperative trimetazidine reduce myocardial injury in patients undergoing first-time elective off-pump CABG?
RCT (n=30)
Placebo-controlled
Randomly assigned
No
Does preoperative trimetazidine reduce myocardial injury in patients undergoing first-time elective off-pump CABG?
Absolute Event Rate: 0.2% vs 0.4%
p-value: p=0.041
Preoperative trimetazidine may reduce postoperative myocardial injury in patients undergoing off-pump CABG, though larger trials are needed to confirm these findings.
May limit myocardial injury in off-pump CABG; hypothesis-generating and requires randomized confirmation before practice change.
Objective. Off-pump coronary artery bypass grafting (CABG) with median sternotomy have been shown to be beneficial and associated with reduced myocardial injury. However, there is still a risk for ischemic myocardial injury that results from the normothermic and metabolically active myocardium during the occlusion of the target coronary artery. We aimed to evaluate the efficacy of trimetazidine in prevention of myocardial tissue injury in patients undergoing off-pump CABG by measuring serum levels of cardiac troponin I (cTnI). Methods. Thirty patients undergoing first-time elective off-pump CABG were randomly assigned to two groups: 15 patients received trimetazidine 60 mg orally per day (trimetazidine group) for three weeks and 15 patients received placebo (control group). As a parameter of myocardial injury, we measured cTnI levels. Blood samples were taken sequentially from the patients before surgery (t1), 30 minutes after the last distal anastomosis (t2), at postoperative 12th hour (t3) and at postoperative 24th hour (t4). cTnI measurements were made by direct chemiluminometric technology. Results. Baseline and operative characteristics of patients are similar. All preoperative serum cTnI concentrations were within the normal range and rose with the beginning of the operation which reached to its peak value at t3 in the control group and t4 in trimetazidine group. When the increase in the serum cTnI concentrations of trimetazidine group and control group were compared there was a slight numerical increase in cTnI levels in all measurements after reperfusion but reached to statistical significance only at t3 (mean: 0.40 ng/ml; mean rank: 12.20; range: 0.05-1.66 vs. mean: 0.20 ng/ml; mean rank: 18.80; range: 0.11-0.30; p=0.041). Conclusion. Preoperative treatment with trimetazidine might reduce postoperative myocardial injury in patients undergoing first time isolated off-pump CABG, but larger randomized placebo controlled trials are still for recommendation of routine pretreatment with trimetazidine.
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Türk et al. (2016) conducted an RCT in Myocardial injury during off-pump coronary artery bypass grafting (n=30). Trimetazidine vs. Placebo was evaluated on Serum cardiac troponin I (cTnI) levels at 12 hours postoperatively (p=0.041). Preoperative treatment with trimetazidine 60 mg/day for three weeks significantly reduced cardiac troponin I levels at 12 hours post-surgery compared to placebo (0.20 ng/ml vs 0.40 ng/ml, p=0.041).
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