Heart 1997;78:353-357 ( October )

Combination treatment with trimetazidine and diltiazem in stable angina pectoris

S C Manchanda,^a S Krishnaswami^b

^a Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India, ^b Department of Cardiology, Christian Medical College Hospital, Vellore, India

Correspondence to: Dr Manchanda, Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110 029, India.

Accepted for publication 24 June 1997

ObjectiveTo assess antianginal efficacy and possible adverse haemodynamic effects of combination treatment with trimetazidine and diltiazem in patients with stable angina.
DesignDouble blind, randomised, placebo controlled trial of four weeks duration.
SettingOutpatient department of two Indian hospitals.
Subjects64 male patients with stable angina, uncontrolled on diltiazem alone.
InterventionsDiltiazem 180 mg and trimetazidine 60 mg, or diltiazem 180 mg and placebo daily.
Main outcome measureChange in exercise time to 1 mm ST segment depression.
Results33 patients (55%) had no exercise induced angina at 3 mm ST segment depression at inclusion in the study (silent ischaemia). Intention to treat analysis showed that of 32 patients in each treatment group, the number (%) of patients responding to trimetazidine compared to placebo was: for anginal attacks, 28 (87.5) v 15 (46.9), p < 0.001; for exercise time to 1 mm ST segment depression, 21 (65.6) v 9 (28.1), p < 0.003; for exercise time to angina, 12 (37.5) v 5 (15.6), p < 0.05; and for maximum work at peak exercise, 17 (53.1) v 8 (25), p < 0.02. Compared to placebo, there was net improvement with trimetazidine in mean anginal attacks of 4.8/week (95% confidence interval (CI) 7.5 to 2.1; p < 0.002); in mean exercise times at 1 mm ST segment depression of 94.2 seconds (95% CI 182.8 to 5.6; p < 0.05), and at onset of angina of 113.1 seconds (95% CI 181.6 to 44.6; p < 0.02); and in mean maximum work at peak exercise of 1.4 metabolic equivalents (95% CI 2.4 to 0.3; p < 0.05).
ConclusionsPatients with stable angina uncontrolled with diltiazem had a clinically important improvement after combination treatment with trimetazidine, without adverse haemodynamic events or increased side effects.

Keywords: trimetazidine;  diltiazem;  blood pressure;  stable angina;  treatment

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© 1997 by Heart
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