This study describes the use of ranolazine (R) for the treatment in patient (P) with chronic stable angina refractory (SAR) to maximal medical treatment.Design and Method:
48 P, 56 y aged, were identified. All P had prior percutaneous coronary intervention and/or coronary artery bypass graft surgery. P with SAR who were receiving standard therapy with beta blockers or calcium antagonists or ace inhibitors were randomized to placebo or R 500mg twice daily, or R 750 mg twice daily.Results:
After 24weeks (w) R group P had a 26% increase in total exercise time (P = .03) and a decrease in anginal episodes / w. The time to onset of 1 mm of ST-segment depression during exercise testing did not change. P in the treatment with R also had an increase in the QT interval. Pre R , antianginal use consisted of beta blockers (98%), long-acting nitrates (79%) and calcium channel blockers (41%). Median blood pressure (124.2/73.8 mmHg) and pulse (63bpm) were controlled. Median pre R angina episodes and sublingual nitroglycerin (SLNTG) doses / w were 21 and 14, respectively, with CCS angina grade of III–IV in 63% of P. After R, median angina episodes / w and SLNTG doses used / w decreased to 0.3 and 0, respectively, with CCS grade of III–IV declining to 22%. 41 P had complete resolution of angina episodes. Treatment with R resulted in a 24- to 56-second improvement in exercise tolerance (P < .001) in P who took 500 to 1500 mg of R twice daily.Conclusions:
The addition of R to maximally tolerated conventional antianginal drug therapy post coronary revascularization was associated with decreases in angina episodes and SLNTG utilization and improvement in CCS angina grades. R may provide an effective treatment option for revascularized P with SAR. R should be seen complementary to medical and interventional therapy of angina.