Is there any benefit of preoperative oral trimetazidine in Coronary Artery Bypass Graft?

Objective: To evaluate the impact of preoperative oral trimetazidine on myocardial protection in coronary bypass surgery. Methods: We conducted a prospective double blind randomized study in the Department of Cardiac Surgery, Chaudhry Pervaiz Elahi (CPE) Institute of Cardiology, Multan, Pakistan. One hundred and seventy (170) patients of isolated CABG were included in the study. All operations were done by conventional technique of CABG using cardiopulmonary bypass, moderate systemic hypothermia and cold antegrade blood cardioplegia. The patients were randomized into 2 groups i.e. Group 1 (n=85), who received and Group 2 (n=85), who did not receive Trimetazidine. Trimetazidine (20mg) was given orally, at 10:00 pm the night before operation and also at 7.00 am on the day of surgery. The CPK and CK-MB levels were determined before operation, immediately after shifting to the ICU, 12 hours and 36 hours after the operation. The comparison of CPK and CK-MB levels was carried out using analysis of variance with repeated measures. The peri-operative clinical and laboratory data were compared using Student s t-test for numeric variables and Chi-square test for categoric varaibles. The difference was considered statistically significant if the p-value was 0.05. Results: The pre-operative variables i.e. age, gender, Canadian Cardiovascular Society (CCS) class, ejection fraction, diabetes, history of smoking, haemoglobin level, serum creatinine etc had no differences in both group. Both groups showed no significant difference in Cardiopulmonary Bypass time (BPT), Aortic cross Clamp Time (CxT), prevalence of intra-operative arrhythmia and need for inotropic support. The analysis did not show any within group or between groups differences in the CPK and CKMB levels. Conclusion: This study showed that oral Trimetazidine given before coronary bypass grafting did not provide any benefit in myocardial protection.