P175Endothelial dysfunction correction in acute coronary syndrome: focus on trimetazidine

Purpose: endothelial dysfunction plays a key role in atherosclerotic plague instability, leading to manifestation of acute coronary syndrome (ACS). The aim of the present study was to evaluate the capability of Trimetazidine as an agent for endothelial function correction in ACS. Methods: 60 patients (34 men and 26 women, mean age 58.7±3.4) with ACS (31 unstable angina pts and 29 myocardial infarction pts) were recruited in the investigation. They were divided randomly into two groups. The 1st group at the same time as receiving standard therapy was treated with Trimetazidine modified-release tablets 35 mg (T-MR) twice daily during 3 months (n=30). The 2nd one received only standard therapy (n=30). The efficacy of treatment was assessed on the basis of ACS clinical course and dynamics of angina symptoms in compared groups. Von Willebrand factor (WF) and Endothelin-1 (E) plasma concentrations were evaluated in all pts with ACS before and after treatment. Results: The compared ACS groups were similar with respect to age, gender, ACS course and associated conditions. There were no differences in WF levels (1.25±0.16 u/ml, 1.22±0.15 u/ml, respectively, p>0.05) and in E levels (2.09±0.28 fmol/ml, 2.03±0.59 fmol/ml, respectively, p>0.05) in two groups before treatment. No severe cardiovascular complications were registered in both groups during investigation. The intensity, frequency, duration of angina episodes and requirement in nitrates decreased more dramatically in the 1st group than in 2nd group after treatment. We defined significant decrease of WF levels on 41% (from 1.25±0.16 to 0.74±0.10 u/ml, p< 0,05) and E levels decrease on 61% (from 2.09±0.28 to 1.28±0.35 fmol/ml, p>0.05) in the 1st group. Lowering of WF and E in 2nd group was not reliable (from 1.22±0.15 to 1.13±0.13 u/ml, p>0.05 and from 2.03±0.59 to 1.77±0.46, p>0.05 respectively). Significant difference in WF levels between groups was noted after treatment: in the 1st group it was lower than in the 2nd (p<0.05). Conclusions: Obtained data suggest the benefits of T-MR in combination with standard therapy for ACS treatment as this regimen not only improves symptoms of ACS but also positively impacts on endothelial function.