The Effect of Trimetazidine Combined with Cardiac Rehabilitation on the Prognosis of Patients with Acute Myocardial Infarction

Abstract

Objective: To investigate the effects of Trimetazidine (TMZ) combined with Cardiac Rehabilitation (CR) on acute myocardial infarction (AMI). A Acute Myocardial Infarction (AMI) patients who underwent PCI, the effects of ventricular remodeling and quality of life at different times after PCI; to observe the changes in the expression of Nod-Like Receptor Protein 3 (NLRP3) in peripheral blood mononuclear cells at different times after the onset of AMI and the effects of TMZ combined with CR therapy on it. Methods: The study population was selected from 89 AMI patients admitted to the Second Hospital of Dalian Medical University from October 2018 to January 2020. All of them underwent PCI in emergency or within 2 days of admission, and they were all treated with double antibiotics, heparin and statins, and β-receptor antagonists or CCB or RAS system antagonists according to the patients' blood pressure and heart rate. The patients were divided into a control group and a rehabilitation group according to their willingness and adherence to rehabilitation. The control group consisted of 44 patients (n=44), who were treated only with the above treatments and no other treatments. The rehabilitation group consisted of 45 patients (n=45) who were treated with TMZ and CR in combination with the above treatments. In the rehabilitation group, the cardiac rehabilitation program was initiated as appropriate from day 2 after PCI, and trimetazidine hydrochloride treatment (35 mg bid po) was given on day 7 after PCI for a total of 1 year (52±2 weeks). Blood was collected in the morning of the 2nd day of admission for routine blood tests, cTnI, lipids, blood glucose, liver and kidney function, and glycosylated hemoglobin. Cardiac ultrasound was performed at weeks 1, 4, 12, and 52±2, and left ventricular end-diastolic diameter (LVEDd) and left ventricular ejection fraction (LVEF) were measured. The Quality of Life Scale (SF-12) and Generalized Anxiety Disorder Scale (GAD-7) were assessed at week 1 and week 52±2. Cardiopulmonary exercise test was performed at week 1 and week 52±2 of onset, and maximum kilogram oxygen uptake (peakVO2/kg), kilogram oxygen uptake at anaerobic threshold (VO2/kg@AT), and metabolic equivalents at anaerobic threshold (Mets@AT) were recorded. The expression of NLRP3 in peripheral blood mononuclear cells of patients at 24-36 hours of onset, week 1, week 4, week 12 and week 52±2 was detected. All the above data were analyzed by SPSS 24.0 software. Results: At 1 year of onset, LVEDd was less in the rehabilitation group than in the control group. At weeks 4 and 12 of onset, LVEF was higher in the rehabilitation group than in the control group. At 1 year after the onset of the disease, the quality of life and anxiety and depression status of the rehabilitation group were significantly improved, the SF-12 score was higher than that of the control group, and the GAD-7 score was lower than that of the control group. And the cardiopulmonary exercise experiment indexes of the two groups were compared, and the peakVO2/kg, VO2/kg@AT and Mets@AT of the rehabilitation group were significantly higher than those of the control group. During the 1-year follow-up, peripheral blood mononuclear cell NLRP3 levels tended to decrease in both groups and were at their highest values at 24-36 hours after onset. At weeks 4 and 12, peripheral blood mononuclear cell NLRP3 levels were significantly lower in the rehabilitation group than in the control group. Conclusion: TMZ combined with CR therapy showed significant improvement in ventricular remodeling, exercise tolerance, and quality of life in patients with AMI, and it was most effective and beneficial to patients at 1 year after PCI. TMZ combined with CR therapy significantly reduced peripheral blood mononuclear cell NLRP3 levels in AMI patients, and the effect was most pronounced at 3 months after PCI.