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

Background/Objectives: Stable angina is a significant health issue in Egypt, often showing poor responses to standard treatments. This study examines the effectiveness and safety of early combination therapy with trimetazidine and either a β-blocker or a calcium channel blocker (CCB) among Egyptian patients with stable angina. Methods: This sub-analysis of the Egyptian cohort from the COMBINE Angina study included patients with stable angina (CCS class II–III) who remained symptomatic after 2–4 weeks of β-blocker or CCB monotherapy. Patients received trimetazidine 35 mg modified-release twice daily as an add-on treatment for 4 months. The primary outcome was the Seattle Angina Questionnaire (SAQ-7) summary score, with secondary outcomes including SAQ-7 domain scores, CCS class, frequency of angina attacks, nitrate use, treatment satisfaction, adherence, and safety. Results: In the global COMBINE study involving 578 patients, the Egyptian cohort had 138 participants with an average age of 58.3 years. The SAQ-7 summary score improved from 42.2 at baseline to 76.8 at month 4 (mean change 34.6 points, 95% CI 31.3 to 38.0; p < 0.0001). All 138 patients contributed data at every visit for the SAQ-7 summary score. Patients in CCS class I increased from 0% to 56.5%, weekly angina attacks fell from 5.0 to 1.7 (p < 0.0001), and short-acting nitrate use decreased from 2.9 to 1.0 doses per week (p < 0.0001). Patient satisfaction was about 75%, and physician satisfaction reached 83% by month 4. Medication adherence also improved (MARS-5 score: 20.8 to 22.7), and two non-serious, treatment-related adverse events (nausea and somnolence) were reported in a single patient (0.7%), with no serious or fatal events. Conclusions: In Egyptian patients with stable angina, implementing an early combination strategy incorporating trimetazidine with 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. As the study was observational and single-arm, these findings are provisional and require confirmation in further long-term controlled studies.