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Myocardial Ischemia After Coronary Bypass: Comparison of Trimetazidine and Diltiazem

Erkan Kuralay, MD, Ufuk Demirkiliç, MD, Erturul Özal, MD, Mehmet Uzun, MD^,1, Harun Tatar, MD

Department of Cardiovascular Surgery 1 Department of Cardiology Gülhane Military Medical Academy Ankara, Turkey

For reprint information contact: Erkan Kuralay, MD Tel: 90 312 326 3855 Fax: 90 312 435 4732 email: ekural{at}gata.edu.tr Gülhane Lojmanlari Pamir Apt. No. 15, Etlik, Ankara 06010, Turkey.

The aim of this prospective randomized study was to evaluate the effect of trimetazidine and diltiazem on persistent myocardial ischemia, mostly silent myocardial ischemia, after coronary artery bypass graft surgery. Sixty patients were divided into three groups of 20 each and followed up for 12 months. Patients in all 3 groups received acetylsalicylic acid 100 mg per day, those in group 1 also had trimetazidine 60 mg per day, and those in group 2 had diltiazem 90 mg per day. Each patient had coronary angiography during the first 3 weeks after surgery, 24-hour ambulatory monitoring every month, and cardiac scintigraphy at 3 weeks, 6 months, and 12 months. Ischemic episodes had resolved at 27 weeks in group 1, at 35 weeks in group 2 and at 51 weeks in group 3 (p < 0.05). Perfusion defects had resolved in the trimetazidine group at 6 months. At 12 months, perfusion defects had resolved in the diltiazem group but not in the group receiving only acetylsalicylic acid (p < 0.05). At these doses, trimetazidine and diltiazem were effective in decreasing silent myocardial ischemia following coronary artery bypass grafting. Trimetazidine appeared to be superior to diltiazem at 6 months on 24-hour ambulatory electrocardiogram monitoring and myocardial scintigraphy.