Coats, Andrew J.

Lopatin, Yuri

Milinković, Ivan

Rosano, Giuseppe

Seferović, Petar M.

Patients presenting with symptoms of angina and/or signs of ischemia may have no visible coronary stenosis on coronary angiography. Myocardial ischemia as a multifactorial process implies that antianginal management should not solely focus on large coronary vessels, but also on the microvessels and cardiac cells. Trimetazidine is an effective and well-tolerated anti-ischemic agent that provides symptom relief and functional improvement, and that offers cytoprotection during ischemia. It has antiischemic and antianginal effects directly on cardiac cells. The drug is suitable for use as a monotherapy and also as an adjunctive therapy when symptoms are inadequately controlled by nitrates, β-blockers, or calcium antagonists. Trimetazidine does not affect hemodynamic variables; it may improve left ventricular function in patients with chronic coronary artery disease or ischemic cardiomyopathy and in ischemia during percutaneous coronary intervention or coronary artery bypass grafting. According to the 2013 European Society of Cardiology (ESC) guidelines for the management of stable coronary artery disease, trimetazidine is indicated as a second-line treatment for angina/ischemia relief. In the 2016 ESC guidelines on diagnosis and treatment of heart failure, trimetazidine is considered for the treatment of stable angina pectoris with symptomatic heart failure with reduced ejection fraction.</p

Clinical benefits of treating angina directly at the cardiac cell level with trimetazidine

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