The efficacy of long-acting trimetazidine 80 mg in complex antianginal pharmacotherapy in patients with coronary heart disease and stable angina pectoris according to the results of the Ukrainian GO-OD study

Abstract

The aim of the study was to evaluate the clinical characteristics of patients’ population with coronary artery disease (CAD), stable angina, the composition and effectiveness of antianginal therapy, including combinations with trimetazidine OD 80 mg (TMZ 80).

Materials and methods. GO-OD was a 3-month, non-interventional, observational, multicentre prospective study. Pharmacotherapy was continued in accordance with current recommendations for optimal medical therapy (OMT). No additional diagnostic or monitoring procedures were performed on patients.

Results. Among 1,529 patients, 10.5 % had ССS I, 60.0 % – CCS II, and 29.5 % – CCS III; 28.5 % received one antianginal drug, 35.7 % received two, and 28.9 % received three. Classic symptoms of angina pectoris were present in 68.3 % of patients, while 80.3% reported angina equivalents. One third remained symptomatic despite revascularisation (32.5 %). BP above 140/90 mmHg was observed in 67.6 % of patients. The effectiveness of therapy optimisation was assessed in the following treatment change groups: 1 – without TMZ, TMZ 80 prescribed for the first time (n = 956); 2 – previously taking TMZ (20 mg or 35 mg), switched to TMZ 80 (n = 328); 3 – beta-blockers (BB) monotherapy, TMZ 80 added (n = 309); 4 – without BB and TMZ, simultaneous prescription of BB + TMZ 80 (n = 211); 5 – had molisodomine in any combination, continued treatment without mandatory addition of BB or TMZ 80 (n = 306). After 3 months in groups 1 and 2 (p < 0.001), starting from the second visit: the frequency of angina attacks per week decreased by 3.72 times and 3.33 times, respectively. In group 3: by 3.29 times and in group 4 by 4.5 times. The frequency of short acting nitrates (SAN) consumption decreased: in group 1 by 4.96 times, in group 2 by 4.62 times; in group 3 by 4.24 times and in group 4 by 6.93 times. In group 5, the frequency of angina attacks decreased by 4.22 times, but slower than in other groups, and the need for SAN decreased by 5.3 times, but against the backdrop of almost total changes in therapy (90.2 %), as well as the exclusion of molisodine (28.4 %) by the doctor’s decision. The proportion of patients with high adherence to treatment (from groups 1 to 4 at the end of follow-up) increased to 48.0 %, 43.9 %, 46.6 % and 46.2 %, respectively.

Conclusions. The population of CAD, angina patients remains symptomatic despite previous revascularisation and the use of monotherapy or combinations of haemodynamic antianginal drugs, which requires a review of antianginal therapy to achieve OMT. The inclusion of TMZ 80 in addition to any previous combination of antianginal drugs or the transition from other forms of TMZ to TMZ 80 is accompanied by a statistically significant improvement in the clinical condition of patients. The maximum positive effect of including TMZ 80 in therapy is observed in the group with simultaneous initiation of BB therapy.