Trimetazidine in the prevention of contrast induced nephropathy following coronary angiography/angioplasty

摘要

Background: Contrast induced nephropathy (CIN) is a knowncomplication following coronary angiography and angioplasty.Rising creatinine levels after coronary procedures is strongly associatedwith poor clinical outcomes. However in clinical practicethere are situations where coronary procedures are necessary forpatients with pre-existing renal dysfunction. There are some clinicalsuggestion that trimetazidine (TMZ), an anti-ischemic drug,may prevent CIN.Methods: To evaluate the efficacy of trimetazidine in the preventionof CIN in patients with pre-existing renal dysfunction undergoingcoronary angiography/angioplasty. It was a prospectivesingle blind randomized trial where 2 groups of patients of classIII angina with serum creatinine values exceeding 1.5 mg/dl wereselected. One group (group A) was administered intravenous (IV)saline (0.9%) infusion at a rate of 1 ml/kg of body weight for 24 hstarting 12 h before the procedure while the other group (group B)received 35 mg twice daily of trimetazidine controlled release (CR)tablet by mouth for 72 h starting 48 h before the procedure inaddition to IV saline infusion like the first group. Baseline serumcreatinine was done 24 h before the procedure for enrolment.Subsequent creatinine values were obtained 1 h before, and 1, 2,and 7 days after the procedure.Results: Over a period of 12 months from April 1, 2014 till March 31,2015, 140 patients were included in this study. There were 98 malepatients. Mean age was 67 14 years. Forty eight percent haddiabetes, while 34% were hypertensive and 28% were smokers.Mean serum creatinine was 1.82 0.44 mg/dl. There were 70patients in group A, who received only saline infusion and remaining70 were in group B who had both IV saline and oral trimetazidineCR. Age, sex, risk factors, and clinical symptoms wereproperly matched in either group. In all nonionic contrast (Iodixanol)was used. One day after angiography/angioplasty there wasno significant change of serum creatinine in either group. Howeveron day 2 post-procedure serum creatinine dropped by mean 8.2%in group A and 9.5% in group B. The difference was not statisticallysignificant. After 7 days of the procedure mean drop of creatininewas 8.8% in group A and 12.6% in group B. Reduction of serumcreatinine after 7 days of angiography/angioplasty by TMZ therapywas statistically significant.Conclusions: The addition of trimetazidine to normal saline significantlydecreased the incidence of CIN in patients undergoingcoronary angiography/angioplasty. In conclusion, trimetazidinecould be considered as a potential tool for prevention of CIN inpatients with renal dysfunction.