In Egyptian patients with stable angina, an early combination strategy adding trimetazidine to first-line β-blocker or CCB therapy was associated with clinically meaningful improvements in angina symptoms, functional status, and quality of life, with good tolerability and high satisfaction; because the study was observational and single-arm, the findings are provisional.
The SAQ-7 summary score rose substantially from baseline to month 4 after adding trimetazidine to β-blocker or CCB monotherapy.
Angina severity by CCS class improved markedly, with over half of patients reaching class I by month 4.
Weekly angina attacks and short-acting nitrate use fell significantly.
Patient and physician satisfaction with treatment were high at month 4.
Medication adherence improved over the 4-month treatment period.
Trimetazidine add-on was well tolerated, with very few adverse events and no serious or fatal events.
The Egyptian cohort was a sub-analysis of the larger global COMBINE Angina study.
The authors caution that the findings are provisional owing to the study's observational, single-arm design.
This study looked at 138 Egyptian patients with stable angina (chest pain from reduced blood flow to the heart) whose symptoms continued despite 2–4 weeks of treatment with a β-blocker or calcium channel blocker. Doctors added a drug called trimetazidine (35 mg twice daily) and followed patients for 4 months. It was part of a larger international study of 578 patients. Over 4 months, patients reported much better quality of life and function on the Seattle Angina Questionnaire (score 42.2 to 76.8). More than half moved to the mildest angina class (from none at baseline), weekly angina attacks fell from about 5 to 1.7, and use of rescue nitrate medication dropped from 2.9 to 1.0 doses per week. Patients and doctors were largely satisfied, adherence to medicines improved, and side effects were rare: one patient (0.7%) had mild nausea and sleepiness, with no serious events. This research suggests that adding trimetazidine early may help people whose angina is not controlled by first-line drugs. However, there was no comparison group, so improvements cannot be definitively attributed to trimetazidine, and the authors say the findings are provisional and need confirmation in longer, controlled studies.
Sobhy M, Elnoamany M, Loutfi M, Mahmoud S, Abdel Ghany M, Salama M, et al.. (2026). Real-World Effectiveness and Safety of Adding Trimetazidine to Standard Antianginal Therapy in Patients with Stable Angina: Egyptian Cohort Findings of the COMBINE Angina Study.. Medical sciences (Basel, Switzerland). https://doi.org/10.3390/medsci14060620