Adding trimetazidine to initial antianginal therapy improved SAQ-7 scores from 39.2 to 78.4 and reduced angina attacks within 4 months in recently diagnosed angina patients.
Does adding trimetazidine to an initial antianginal drug improve symptoms and quality of life in recently diagnosed stable angina patients?
The early addition of trimetazidine to standard hemodynamic antianginal therapy significantly improves symptoms and quality of life in patients with recently diagnosed stable angina.
Absolute Event Rate: 0% vs 0%
Abstract Background The latest ESC guidelines for managing chronic coronary syndromes consider early combination of antianginal drugs for adequate symptoms control. Given the various mechanisms of myocardial ischemia, drugs with different modes of action may be preferable. Trimetazidine (TMZ) is recognized for its anti-ischemic benefits due to its ability to modulate myocardial energy production. Purpose The COMBINE Angina study aimed to evaluate the benefits of TMZ as an adjunct therapy in patients recently diagnosed with stable angina who remained symptomatic after a first hemodynamic antianginal drug. Methods This international, prospective, non-interventional study included stable angina patients from 37 sites in five countries between June 2023 to June 2024. It aimed assessing the effectiveness and tolerability of adding TMZ early to an initial antianginal drug chosen by the participating physician. Data on clinical profiles and antianginal effectiveness were collected at baseline, 2-week, 1- and 4-month follow-ups. The primary endpoint was the Seattle Angina Questionnaire-7 Items (SAQ-7) change. Additional data included weekly angina attacks, effort-induced angina severity (Canadian Cardiovascular Society CCS grading), physician and patient satisfaction, and treatment tolerability. Results The study included 578 patients (mean age 59.3±10.7 years, 50% female) with angina diagnosed with a mean of 1.0±1.0 month before inclusion and 5.7±5.3 weekly angina attacks at baseline. Comorbidities were hypertension (73.5%), dyslipidemia (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 drugs (76.1%). 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) (p0.001). Significant improvement of angina attacks and CCS classification were also reported, starting at 2 weeks (p0.001). 90.8% of patients maintained the same antianginal treatment throughout the study, and 0.7% underwent revascularization. 89.8% of patients were satisfied or very satisfied with their treatment. 91.6% of physicians expressed satisfaction with treatment's effectiveness, and 95% with its tolerability. At 4 months, 16.7% of patients reported residual angina, as measured by the SAQ-7 angina sub-score. Adverse events occurred in 3.3% of patients, with 0.7% related to treatment and categorized as non-serious. Conclusion The study showed that combining TMZ with a hemodynamic antianginal drug early, significantly relieves symptoms, reduces physical limitations, and enhances overall quality of life. These insights can guide clinical decisions and help optimize treatment strategies for recently diagnosed angina patients.
Marzilli et al. (Sat,) reported a other. Adding trimetazidine to initial antianginal therapy improved SAQ-7 scores from 39.2 to 78.4 and reduced angina attacks within 4 months in recently diagnosed angina patients.
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