Combination therapy rapidly improves symptoms and quality of life in recently diagnosed angina patients: the COMBINE Angina study
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".