Early Addition of Trimetazidine to First-Line Standard of Care Rapidly Improves Symptoms and Quality of Life in Recently Diagnosed Stable Angina Patients: The COMBINE- Angina Study
The COMBINE Angina study results were presented at the ESC Congress 2025 held in Madrid, Spain. The study aimed to evaluate the benefits of early addition of trimetazidine in patients recently diagnosed with stable angina, who remained symptomatic even after first line hemodynamic agent.
This international, prospective, non-interventional study included stable angina patients from five countries including India, between June 2023 to June 2024. It aimed at assessing the effectiveness and tolerability of adding Trimetazidine early to an initial antianginal agent chosen by the participating physician. Addition of trimetazidine was a part of routine clinical practice, and follow-up visits were planned after 2 weeks, 1 month, and 4 months. Outcomes assessed during follow-up included SAQ-7 scores (physical limitation, angina frequency, quality of life, and overall summary scores); CCS class; the number of angina attacks and short-acting nitrate uses in the previous week; patient- and physician-reported treatment satisfaction; and the incidence and severity of adverse events (AEs).
The study included 578 patients (mean age 59.3±10.7 years, 50% female) with angina diagnosed as a mean of 1.0±1.0 months before inclusion and 5.7±5.3 weekly angina attacks. Comorbidities were hypertension (73.5%), dyslipidaemia (61.9%), obesity (37%), and diabetes (29.9%). Baseline therapy included beta-blockers (82.4%), calcium channel blockers (17.5%), short-acting nitrates (39.4%), antiplatelets (43.9%), and lipid-lowering agents (76.1%).
Key Findings of the study:
- A significant improvement in the SAQ-7 summary score was observed during the study, from 39.2±13.7 at baseline (fair health status) to 53.2±16.1 at 2 weeks (good health status), 64.4±17.4 at 1 month and 78.4±16.3 at 4 months (excellent health status) (P < 0.0001).
- Significant improvement in angina attacks and CCS classification was also reported, starting at 2 weeks (P < 0.0001).
- Patient satisfaction was high, with 89.8% being satisfied or very satisfied with their treatment. 91.6% of physicians expressed satisfaction with the treatment’s effectiveness, and 95% with its tolerability.
Conclusion: The COMBINE angina study showed that early addition of Trimetazidine to a hemodynamic agent in recently diagnosed stable angina patients significantly relieves symptoms, reduces physical limitations, and enhances overall quality of life. These findings can guide clinical decisions and help optimize treatment strategies for stable angina.
Reference: Combination therapy rapidly improves symptoms and quality of life in recently diagnosed angina patients: the COMBINE Angina study; Session: Pharmacotherapy in coronary artery disease (2) ; Topic: Pharmacotherapy ; Speaker: Professor M. Marzilli (Pisa, IT) ; Event: ESC Congress 2025 available at: https://esc365.escardio.org/presentation/303890
