Trimetazidine in Acute Coronary Syndrome
Guideline Recommendations
- The European Society of Cardiology (ESC) does not recommend trimetazidine for routine use in acute coronary syndrome (ACS) management, as stated in the 2011 and 2015 ESC guidelines 1, 2
- The 2024 ESC Guidelines for Chronic Coronary Syndromes have downgraded trimetazidine to a Class IIb recommendation as add-on therapy for chronic stable angina, only when symptoms are inadequately controlled on beta-blockers and/or calcium channel blockers 3, 4
- Trimetazidine is explicitly positioned as a second-line agent for chronic stable angina, not for ACS, according to the 2024 ESC guidelines 4, 6
Clinical Use
- The American College of Cardiology and European Society of Cardiology recommend focusing on guideline-directed medical therapy, including dual antiplatelet therapy, beta-blockers, ACE inhibitors/ARBs, and high-intensity statins, for patients presenting with ACS 1, 2
- Trimetazidine may be considered as third-line add-on therapy for persistent angina in chronic coronary syndrome patients, but only after optimal first-line antianginal therapy has been tried, as per the 2024 ESC guidelines 3, 4