Journal
CLINICAL CARDIOLOGY
Volume 38, Issue 8, Pages 469-475Publisher
WILEY
DOI: 10.1002/clc.22425
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Funding
- Boehringer Ingelheim
- TIMI Study Group
- Brigham and Women's Hospital from AstraZeneca
- Bristol-Myers Squibb
- Daiichi-Sankyo
- GlaxoSmithKline
- Johnson and Johnson
- Bayer Healthcare
- Gilead
- Eisai
- Merck
- Brigham and Women's Hospital from Accumetrics
- Amgen
- AstraZeneca
- Beckman Coulter
- CV Therapeutics
- Daiichi Sankyo Co Ltd
- Eli Lilly and Co
- Integrated Therapeutics
- Merck and Co
- Nanosphere
- Novartis Pharmaceuticals
- Nuvelo
- Ortho-Clinical Diagnostics
- Pfizer
- Roche Diagnostics
- Sanofi-Aventis
- Sanofi-Synthelabo
- Siemens Medical Solutions
- Singulex
- Abbott Laboratories
- Daiichi Sankyo
- diaDexus
- Instrumentation Laboratory
- Konica Minolta
- Novartis
- TIMI Study
- Arena
- Boston Clinical Research Institute
- Covance
- Elsevier Practice Update Cardiology
- Forest Pharmaceuticals
- GE Healthcare
- Lexicon
- St. Jude's Medical
- University of Calgary
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BackgroundRanolazine, a piperazine derivative with anti-ischemic effects, reduces the frequency of angina and improves exercise performance in patients with chronic angina. The effects of ranolazine in patients with established ischemic heart disease and chronic angina undergoing percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) is not well described. We hypothesized that ranolazine would reduce ischemic events, regardless of revascularization. MethodsWe examined the 1-year incidence of recurrent cardiovascular (CV) events in the subgroup of patients with prior chronic angina (n=3565) enrolled in the randomized, double-blind, placebo-controlled Metabolic Efficiency with Ranolazine for Less Ischemia in Non-ST-Elevation ACS (MERLIN)-Thrombolysis In Myocardial Infarction (TIMI) 36 trial who did or did not have a PCI within 30 days of the index event. ResultsRanolazine reduced the risk of recurrent ischemia following admission regardless of whether patients had (hazard ratio [HR], 0.69; 95% confidence interval [CI] 0.51-0.92] or did not have PCI (HR, 0.81; 95% CI, 0.66-0.99; P interaction=0.39). CV death, myocardial infarction, and recurrent ischemia were similarly lower with ranolazine in the PCI group (HR, 0.71; 95% CI, 0.55-0.91) vs the non-PCI group (HR, 0.91; 95% CI, 0.78-1.06; P interaction=0.10), with a nominally significant decrease in CV death (HR, 0.39; 95% CI, 0.16-0.93) in the PCI group vs no difference in the non-PCI group (HR, 1.19; 95% CI, 0.89-1.59; P interaction=0.02). ConclusionsIn patients with chronic angina, ranolazine reduced recurrent ischemic events, regardless of whether patients did or did not receive PCI within 30 days of a non-ST-segment ACS.
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