Abstract
Objectives
The aim of this cohort study was to retrospectively evaluate, in patients with chronic
heart failure (CHF), the long term effect of trimetazidine (TMZ) on morbidity and
mortality.
Background
Previous small studies in patients with CHF have shown that TMZ can improve left ventricular
function, exercise capacity and NYHA class compared to placebo. However, no data on
the effects of TMZ on survival in patients with CHF have ever been produced.
Methods
In this international multicentre retrospective cohort study data from 669 patients
were analyzed. 362 patients were on TMZ due to symptom persistence despite up-titration
of optimal CHF therapy, while the remaining patients continued conventional CHF therapy
alone. Propensity score analysis was performed in order to minimize selection bias
between the two groups.
Results
Kaplan–Meier analysis for global mortality showed 11.3% improved global survival (p=0.015) and 8.5% improved survival for cardiovascular (CVD) death (p=0.050) in the TMZ group. Cox regression analysis for global mortality showed a significant
risk reduction for TMZ treated patients with a hazard ratio (HR)=0.189 (confidence interval — CI 95%: 0.017–0.454; p=0.0002). TMZ also showed a good risk reduction profile for CVD death causes (HR=0.072, CI 95%: 0.019–0.268, p=0.0001). The rate of hospitalization for cardiovascular causes was reduced by 10.4%
at 5 years (p<0.0005) with increased hospitalization-free survival of 7.8 months.
Conclusion
TMZ is effective in reducing mortality and event-free survival in patients with CHF.
The addition of TMZ on top of optimal medical therapy improves long term survival
in CHF patients.
Keywords
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Article info
Publication history
Published online: October 16, 2012
Accepted:
September 22,
2012
Received in revised form:
September 19,
2012
Received:
July 19,
2012
Footnotes
☆Conflicts of interest and sources of funding. GF has received travel grants and performed remunerated lectures for Servier, manufacturer of trimetazidine; last lecture was performed in May 2009. HS has received travel grants from Servier, manufacturer of trimetazidine, in 2010 and 2011. PDN in the past has received travel grants and performed remunerated lectures for Servier, manufacturer of trimetazidine. All other authors confirm that they do not have any relationships that they believe could be construed as resulting in an actual, potential, or apparent conflict of interest with regard to the manuscript submitted for review. Authors have no direct or indirect commercial financial incentive associated with publishing the article; no commercial funding is associated with this manuscript. This is a self-sponsored study with no external funding.
Identification
Copyright
© 2012 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
