Impact of Trimetazidine on the Incident Heart Failure Following Coronary Artery Revascularization.

Abnormal myocardial metabolism is a common pathophysiological process underlying ischemic heart disease and heart failure (HF). Trimetazidine is an anti-anginal agent with a unique mechanism of action that regulates myocardial energy metabolism and might have a beneficial effect in preventing HF in patients undergoing myocardial revascularization. We aimed to evaluate the potential benefit of trimetazidine in preventing incident hospitalization for HF following myocardial revascularization. Using the common data model, we identified patients without prior HF undergoing myocardial revascularization from eight hospital databases in Korea. To compare clinical outcomes using trimetazidine, database-level hazard ratios (HRs) were estimated using large-scale propensity score matching (PSM) for each database and pooled using a random-effects model. The primary outcome was incident hospitalization for HF. The secondary outcome of interest was major adverse cardiac events (MACE). After PSM, 6,724 and 11,211 patients were allocated to trimetazidine new-users and non-users, respectively. There was no significant difference in the incidence of hospitalization for HF between the two groups (HR 1.08, 95% confidence interval [CI] 0.88-1.31; p = 0.46). The risk of MACE also did not differ between the two groups (HR 1.07, 95% CI 0.98-1.16; p = 0.15). In conclusion, the use of trimetazidine did not reduce the risk of hospitalization for HF or MACE in patients undergoing myocardial revascularization. Therefore, the role of trimetazidine in contemporary clinical practice cannot be expanded beyond its current role as an add-on treatment for symptomatic angina.