Ischemic heart disease (IHD) is characterized pathologically by the atheromatous plaque which may induce stenosis or obstruction of the coronary arterial lumen leading to myocardial ischemia, experienced by the patients as chest pain. Plaque rupture provides a focus for platelet deposition and thrombosis, and results in unstable angina or myocardial infarction. Stable angina pectoris is treated conventionally by using beta blockers, nitrates and calcium channel blockers (CCB), all of which act by either increasing the supply or decreasing the demand of oxygen in myocardium. In recent years a group of drugs known as metabolic modulators have been particularly shown to be beneficial in protecting the myocardium. Trimetazidine has been a special target in this group. It has been found that in ischemic myocardium there is high rate of fatty acid (FA) oxidation and subsequent inhibition of glucose oxidation. This drug is thought to have direct cytoprotective action in ischemic myocardium through inhibition of the oxidation of FA. Numerous studies are still being carried out to further clarify its roles in various other conditions related directly or indirectly with IHD. The purpose of the review was to assimilate the results of various trials done all over the world in the recent years to find out the role in IHD and the exact mechanism of action, in order to know its true worth in myocardial protection.