improving survival in symptomatic ischemic patients with left ventricular dysfunction beneficial...
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Improving survivalin symptomatic ischemic patients with
left ventricular dysfunction
Beneficial effects oflong-term trimetazidine* therapy
Fragasso G et al. Int J Cardiol. In press.
Presented at AHA 2012
Presented at AHA 2012
*Trimetazidine is indicated by the European Medecines Agency (EMA) as add-on therapy for the symptomatic treatment of patients with stable angina pectoris who are inadequately controlled by or intolerant to first-line antianginal therapies.
What do preliminary data say?
Gaometa-analysis
n=61Patients with severe ischemic cardiomyopathy
El Kady T et al. Am J Cardiovasc Drugs. 2005;5:271-278.Di Napoli P et al. J Cardiovasc Pharmacol. 2007;50:585-589.Fragasso et al. J Am Coll Cardiol. 2006;48:992-998.
Iyengar S et al. Am J Cardiovasc Drugs. 2009;9:293-297.Gao D et al. Heart. 2011;97(4):278-286.Zhang L et al. J Am Coll Cardiol. 2012;59:913-922.
Zhangmeta-analysis
A study with a homogeneous and relevantly sized population is needed.
METROStudy
El-KadyStudy
n=955Heart failure patients
n=200Angina patients with ischemic left ventricular dysfunction
2005 20092007 2012
Di NapoliStudy
n=353Angina patients with acute myocardial infarction
n=884Heart failure patients
=> First data on mortality evaluated as a safety parameter
=> Complemen-tary results on mortality in a small population
=> Primary objective was to assess the 6-month survival rate
2011
=> First meta-analysis demonstrating mortality results
n=number of patients.
n=65Patients with heart failure
2006
FragassoStudy
=> First results on mortality in a small population
Kim J et al. WCC 2012. Abstract 1621.
2006
A new study designed to evaluate survival
• International multicenter retrospective cohort study
• Inclusion criteria:– Ejection fraction ≤ 45%– NYHA Class II-IV– Trimetazidine (TMZ) administered if symptoms persist despite correct
titration of standard medical therapy for chronic heart failure (CHF)
• CHF was of ischemic origin in >80% of patients
• Mean follow-up: 3 years
• Propensity score
669 Symptomatic heart failure patients669 Symptomatic heart failure patients
Fragasso G et al. Int J Cardiol. In press.
TMZ improves survival
TMZ significantly improves global survival by 11.3% (P=0.015).
TMZ significantly improves global survival by 11.3% (P=0.015).
Global survival Event-free survival
Fragasso G et al. Int J Cardiol. In press.
TMZ reduces global and cardiovascular mortality
Heart failure patients live longer with TMZ.Heart failure patients live longer with TMZ.
Fragasso G et al. Int J Cardiol. In press.
TMZ reduces rate of hospitalizationfor cardiovascular causes
Heart failure patients live better with TMZ.Heart failure patients live better with TMZ.
Fragasso G et al. Int J Cardiol. In press.
• The addition of TMZ to standard medical therapy in patients with CHF significantly reduces total and cardiovascular mortality and improves event-free survival.
• Therefore, this study confirms in a homogeneous and relevantly sized population that TMZ should be considered as a potential additional medication to standard therapy in CHF patients.
• These results could be explained by the ability of TMZ to reduce ischemia whatever the causal mechanism, and therefore to protect the heart from subsequent damage.
Conclusion:
Fragasso G et al. Int J Cardiol. In press.