Trimetazidine Effect on Neutrophils count in Post IKKP


Background: Reperfusion strategy, either with thrombolytic or Primary Percutaneous Coronary Intervention (PPCI), is the core treatment for Acute ST-Segment Elevation Myocardial Infarct (STEMI). The goal of PPCI is to restore the patency of infarcted epicardial artery and establish microvascular reperfusion as soon as possible so that necrotic myocardial area can be reduced. However, successful restoration of infarcted epicardial artery is not always followed by enough reperfusion to the microvascular part. Trimetazidine can reduce neutrophil which was mediated by tissue trauma during ischemic heart condition. Unfortunately, its influence over neutrophil accumulation in acute STEMI patients which undergo PPCI is not well understood.
Method: There were 68 consecutive-selected acute STEMI patients which undergo PPCI since January 2015 until Juni 2015. They were admitted in emergency department. Peripheral vein blood sampling was taken to measure neutrophil before PPCI was performed. Six hour after PPCI was conducted, another peripheral vein blood sampling was taken for another neutrophil measurement. Neutrophil measurement was performed with Sysmex 2000i. Statistical analysis was performed by using SPSS 17.
Result: Among 68 patients, divided in two groups, trimetazidine 28 patients and plasebo 40 patients. There were no differences amount of neutrophils in trimetazidine or plasebo group, before or after PPCI. Neutrophil pre PPCI in trimetazidine vs plasebo group 10.71 ± 3.263 vs 10.99 ± 3.083, p:0,341. Neutrophil post PPCI in trimetazidine vs plasebo group 9.49 ± 3.135 vs 9.92 ± 3.463, p:0,664.
Conclusion: There were no reducing amount of neutrophils after trimetazidine was given in patients STEMI which underwent PPCI


Download data is not yet available.


1. Steg G, James SK, Atar D, Badano LP and Borger MA. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal. 2012; 33: 2569-619.

2. Soerianata S and Juzar DA. iSTEMI Network Pilot Program West Jakarta. Jakarta2014.

3. Niccoli G, Burzotta F, Galiuto L and Crea F. Myocardial No-Reflow in Humans. Journal American College of Cardiology. 2009; 54: 281-92.

4. David D. McManus, Gore J, Yarzebski J, Spencer F, Lessard D and Goldberg RJ. Recent Trends in the Incidence, Treatment, and Outcomes of Patients with ST and Non-ST-Segment Acute Myocardial Infarction. Am J Med. 2011; 124: 40-7.

5. Ito H, Tomooka T, Sakai N, Yu H, Higashino Y and Fujii K. Lack of Myocardial Perfusion Immediately After Successful Thrombolysis A Predictor of Poor Recovery of Left Ventricular Function in Anterior Myocardial Infarction. Circulation 1992; 85: 1699-705.

6. Kang S and Yang Y. Coronary microvascular reperfusion injury and no-reflow in acute myocardial infarction. Clin Invest Med 2007; 30(3): E133-E45.

7. Reffelmann T and Kloner RA. The “no-reflow” phenomenon: basic science and clinical correlates. Heart Journal. 2002; 87: 162-8.

8. Engler RL, Schmid-Schonbein GW and Pavelec RS. Leukocyte Capillary Plugging in Myocardial Ischemia and Reperfusion in the Dog. American Journal Pathology. 1983; 111: 98-111.

9. Tritto I, Wang P, Kuppusamy P, Giraldez R, Zweier JL and Ambrosio G. The anti-anginal drug trimetazidine reduces neutrophil-mediated cardiac reperfusion injury. J Cardiovasc Pharmacol. 2005; 46: 89-98.

10. Vinten-Johansen J. Involvement of neutrophils in the pathogenesis of lethal myocardial reperfusion injury. Cardiovascular Research. 2004; 61: 481-97.

11. Lavanchy N, Martin J and Rossi A. [Trimetazidine preservation of the energy potential of the myocardium during ischemia and reperfusion. Phosphorus NMR spectroscopy study of the isolated heart]. Presse Med. 1986; 15: 1758-61.

12. Renaud JF. Internal pH, Na+, and Ca2+ regulation by trimetazidine during cardiac cell acidosis. Cardiovascular Drug Therapy. 1988; 6: 677-86.

13. Guarnieri C and Muscari C. Beneficial effects of trimetazidine on mitochondrial function and superoxide production in the cardiac muscle of monocrotaline-treated rats. Biochemical pharmacology. 1988; 37: 4685-8.

14. F. M Williams KT, M. Kus, T. J Williams. Trimetazidine inhibits Neutrophil Accumulation After Myocadial Ischaemia and Reperfusion in Rabbits. Journal of Cardiovascular Pharmacology. 1993; 22: 828-33.

15. H.M.Piper, D.Garc?a-Dorado and M.Ovize. A fresh look at reperfusion injury. Cardiovascular Research. 1998; 38: 291-300.

16. Foad Khaled EA, Bastawy Islam,Khaled Saeed. Effect of trimetazidine on myocardial salvage index in patients with acute ST segment elevation myocardial infarction undergoing primary PCI. The Egyptian Heart Journal. 2013; 65: 181-9.

17. Kim J, Kim C, Chun K, et al. Effects of trimetazidine in patients with acute myocardial infarction: data from the Korean Acute Myocardial Infarction Registry. Clinical Research in Cardiology. 2013; 102: 915-22.

18. Weerawadee Chandranipapongse SC, Tullaya Ruangnapa, Suthathip Ngokpol, Korbtham Sathirakul, Piyapat Pongnarin. Bioequivalence Study of Two Formulations of 35mg Trimetazidine Modified Release Tablets in Healthy Thai Volunteers Under Fasting and Fed Conditions. J Bioequiv 2011; 3: 052-5.

19. Chatelain P, Latour JG, Tran D, de Lorgeril M, Dupras G and Bourassa M. Neutrophil accumulation in experimental myocardial infarcts: relation with extent of injury and effect of reperfusion. Circulation. 1987; 75: 1083-90.

20. Zhi Qing Zhao MN, Ning Ping Wang, Karlene O, Robert A Guyton,et al. Dynamic Progression of Contractile and Endothelial Dysfunction and Infarct Extension in the Late Phase of Reperfusion. Journal Of Surgical Research. 2000; 9: 133-44.

21. Robert F Bonvini TH, Edoardo Camenzind. Inflammatory response post-myocardial infarction and reperfusion : a new therapeutic target? European Heart Journal Supplements. 2005; 7: 127-36.

22. Kulasegaram Ranjadayalan VU, Simon W Davies, Denise Syndercombe-Court, Charles N Gutteridge, Adam D Timmis. Thrombolytic treatment in acute myocardial infarction: neutrophil activation, peripheral leucocyte responses, and myocardial injury. Br Heart J 1991; 66: 10-4.
Abstract views: 57   
PDF downloads: 0   
How to Cite
Trimetazidine Effect on Neutrophils count in Post IKKP. (2016). Indonesian Journal of Cardiology, 36(4), 202-8.
Clinical Research