BACKGROUND: As cardiac interventional medicine continues to advance, the occurrence of contrast-induced nephropathy (CIN) is on the rise each year. Trimetazidine, an anti-ischemic medication, has shown a noteworthy capability to reduce the occurrence of CIN. A systematic review and meta-analysis were carried out to assess trimetazidine’s clinical impact in preventing CIN in patients undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI), regardless of the trimetazidine dose given. This meta-analysis aims to strengthen the latest data on the significance of administering a specific dose of oral trimetazidine (35 mg/tab twice daily for 72 hours) on elderly patients for prevention of CIN. METHODS: A systematic review was conducted to find clinical trials that assess trimetazidine’s impact on the occurrence of CIN in elderly patients undergoing CAG/PCI up to January 2023. The search was carried out on databases including PubMed, Scopus, and Google Scholar. All were elderly patients (age >50 years) given oral trimetazidine 35 mg/tab twice daily for 72 hours, and the outcome of interest was the occurrence of CIN, decrease in serum creatinine, and improvement in creatinine clearance. RESULTS: The analysis of serum creatinine levels at various post-procedure time points revealed differing outcomes. At 24 hours post procedure, the trimetazidine group exhibited a significant average decrease of 0.09 mg/dL compared to control groups (95% CI -0.14, -0.03; p=0.003), with minimal heterogeneity. However, at 48 and 72 hours post procedure, the evidence was inconclusive, with varying levels of heterogeneity, suggesting result variability. A comprehensive analysis of all available studies indicated an average serum creatinine reduction of 0.13 mg/dL in the trimetazidine group, with statistical significance, although substantial heterogeneity was observed. Creatinine clearance at 72 hours post procedure showed an average increase in the trimetazidine group and minimal heterogeneity was present. An analysis of CIN rates across six studies demonstrated a risk ratio of 0.55, indicating a 45% reduction in CIN risk with trimetazidine, and a risk difference of 0.07, signifying 7 fewer expected CIN cases per 100 individuals treated with trimetazidine, with minimal heterogeneity observed in both analyses. CONCLUSION Administering trimetazidine 35 mg/tab twice daily for 72 hours significantly decreases CIN risk in elderly patients undergoing CAG/PCI.
Human ; Trimetazidine