Efficacy of trimetazidine in patients with recurrent angina: a subgroup analysis of the TRIMPOL II study.

OBJECTIVES: The revascularization procedures become more and more popular to treat coronary artery disease, in many countries. Some patients are free of angina after revascularization, without any documented re-stenosis present with recurrent angina symptoms after a period of time. The aim of this work was to assess the efficacy of trimetazidine in the subpopulation of patients with a history of PTCA or CABG, who were included in the TRIMPOL II study. METHODOLOGY: A subgroup of 94 patients was retrospectively analysed from the TRIMPOL II study, a multicentre, double-blind randomised placebo-controlled trial in 426 patients with stable effort angina. These patients have a history of revascularization for coronary artery disease, and they are still symptomatic after 6 months despite a treatment with metoprolol (50 mg twice daily). They were randomly allocated to receive either trimetazidine (20 mg 3 times daily) or placebo for 12 weeks, on top of the beta-blocker. Exercise test parameters, clinical efficacy and safety were assessed. Results were analysed using the Student test, the Mann-Whitney test or the Shapiro-Wilk test. RESULTS: Compared to placebo, the 12-week treatment with trimetazidine significantly improved: time to 1 mm ST segment depression (385.1 s +/- 144.6 s versus 465.0 s +/- 143.8 s [p < 0.01]); exercise test duration (466.9 s +/- 144.8 s versus 524.4 s +/- 131.5 s [p = 0.048]), total workload (9.0 m.e. +/- 2.4 m.e versus 10.1 m.e. +/- 2.4 m.e [p = 0.035]) as well as time to onset of angina (433.6 s +/- 164 s versus 508.1 s +/- 132.4 s [p = 0.031]). Weekly number of angina attacks and nitrate consumption were significantly reduced in the trimetazidine group when compared to placebo. Three mild gastro-intestinal side-effects were reported in the trimetazidine group. CONCLUSION: These results show that trimetazidine provides anti-anginal efficacy in post-revascularized patients with recurrent angina despite a monotherapy with metoprolol. The treatment was well accepted.

[Massive pericardial effusion during the course of hematological diseases]. / Masywne wysieki osierdziowe w przebiegu chorób hematologicznych.

7 patients, 4F/3M aged 20-63 years (x = 39.5 yrs) with high grade non-Hodgkin lymphoma (4 pts), Hodgkin's disease (1), acute leukaemia (1) and blastic crisis of CML (1), complicated by massive pericardial effusion with impending cardiac tamponade were presented. Symptoms of neoplastic pericardium infiltration have appeared at the diagnosis of underlying disease in 2 pts, in the remaining 5.5-24.5 months (mean = 12.5 months) since the diagnosis and onset of cytostatic treatment was established. In 6 pts pericadiocentesis or pericardium drainage have been applied, resulting in evacuation of 100-1450 ml (mean = 680 ml) of fluid. In 3 pts pericardial effusion was bloody and in two some neoplastic cells were found. In 4 pts intrapericardially 5-20 mg mitoxantrone, 5-20 mg, was administered 7 times. The survival time since the diagnosis of a massive pericardial effusion ranged 0.5-10 months. One person remains alive 7 months after diagnosis of cardiac effusion and 19 months from the diagnosis of n-HL. The authors conclude that pericardiac involvement in the course of haematologic malignancies is a very unfavorable event.