Combination therapy rapidly improves symptoms and quality of life in recently diagnosed angina patients: the COMBINE Angina study
Notice bibliographique
Résumé
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) (p<0.001). Significant improvement of angina attacks and CCS classification were also reported, starting at 2 weeks (p<0.001). 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.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,002 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».