Trimetazidine effect on kidney function in patients undergoing coronary procedures

Abstract

BACKGROUND: CIN (Contrast-induced Nephropathy) was studied after Percutaneous Coronary Intervention (PCI) or Coronary Angiography (CA). Trimetazidine (TMZ) has been investigated as one of the potential molecules that may protect against CIN by its anti-ischemic, antioxidant, and mitochondrial protective effects. We aimed to observe the reno-protective value of TMZ when added to the Guidelines Directed Medical Therapy (GDMT) in patients receiving contrast. METHODS: This cohort observational prospective study included 410 patients with Chronic Coronary Syndrome (CCS) undertaking elective CA or PCI. We observed the kidney function following the non-ionic contrast exposure in Group I (205 patients), who received all the GDMT and TMZ. We compared the results with another Group II (205 patients) who received all the GDMT without TMZ. The primary endpoint was the development of CIN, and the secondary endpoint was follow-up kidney function after one month. RESULTS: The baseline characteristics of Group I and Group II were similar, with the weighted groups looking very well matched. All Standardized Mean Differences (SMDs) were either below or very close to 0.1.CIN rates at 72 h were lower in Group I (13.2%) than Group II (22.0%; unadjusted p = 0.019, Bonferroni-adjusted p = 0.352, FDR-adjusted p = 0.047), suggesting a modest protective effect of TMZ that weakens under stringent correction but remains borderline significant with FDR. By one month, CIN rates were 6.3% in Group I vs. 13.2% in Group II (unadjusted p = 0.020, Bonferroni-adjusted p = 0.060, FDR-adjusted p = 0.050), reinforcing TMZ's borderline significant potential long-term benefit. CONCLUSION: Our Cohort Observational Single-Center study showed that TMZ did not provide robust protection against CIN at 72 h. However, TMZ may offer a modest, clinically relevant, longer-term renal benefit at one month in patients undergoing elective coronary procedures. Further randomized trials are warranted to validate TMZ's efficacy and explore its mechanisms. CLINICAL TRIAL NUMBER: Not applicable.