The Role of Ranolazine for the Treatment of Residual Angina beyond the Percutaneous Coronary Revascularization

Introduction. Despite a successful percutaneous coronary intervention (PCI), several studies reported that the recurrence of angina after revascularization, even complete, is a particularly frequent occurrence in the first year after PCI. Methods. The aim was to evaluate the efficacy of treatment with ranolazine in addition to conventional anti-ischemic therapy in patients who underwent coronary angiography for persistent/recurrent angina after PCI and residual ischemia only due to small branches not suitable for further revascularization. Forty-nine consecutive patients were included in our registry, adding the ranolazine (375 mg b.i.d) to optimal medical therapy (OMT). The Exercise ECG Test (EET) was performed in all patients before to start the therapy (baseline BL) and at 30 days (T1) after enrollment. Results. The average duration of the exercise was increased after the therapy with ranolazine comparing to baseline (RG 9’1” ± 2’ versus BL 8’10” ± 2’, p = 0.01). Seven (14.3%) patients after receiving ranolazine had not crossed the threshold of six minutes (75 watts) compared to 20 (40.8%) of BL (p = 0.0003). Stress angina appeared more frequently at BL than at 30 days (T1 4.1% versus BL 16.3%, p = 0.04) as well as exercise-induced arrhythmias (BL 30.6% versus T1 14.3%, p = 0.05). Conclusions. The addition of ranolazine to standard anti-ischemic therapy showed a significant improvement in EET results after one month of therapy, including reduced exercise angina, increased exercise tolerance, and reduced exercise arrhythmias.

[1]  Marco Valgimigli,et al.  2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. , 2019, European heart journal.

[2]  Jinyu Huang,et al.  Effects of the Antianginal Drugs Ranolazine, Nicorandil, and Ivabradine on Coronary Microvascular Function in Patients With Nonobstructive Coronary Artery Disease: a Meta-analysis of Randomized Controlled Trials. , 2019, Clinical therapeutics.

[3]  U. Baber,et al.  Safety and Efficacy of Polymer-Free Drug-Eluting Stents: Amphilimus-Eluting Cre8 Versus Biolimus-Eluting BioFreedom Stents , 2019, Circulation. Cardiovascular interventions.

[4]  F. Fedele,et al.  Effects of Ivabradine on Residual Myocardial Ischemia after PCI Evaluated by Stress Echocardiography , 2019, Cardiology research and practice.

[5]  Mahraz Parvand,et al.  Ranolazine for Symptomatic Management of Microvascular Angina. , 2020, American journal of therapeutics.

[6]  C. Briguori,et al.  Safety and efficacy of polymer-free biolimus-eluting stents in all-comer patients: the RUDI-FREE study. , 2018, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology.

[7]  P. Stella,et al.  Clinical outcomes with reservoir‐based polymer‐free amphilimus‐eluting stents in real‐world patients according to diabetes mellitus and complexity: The INVESTIG8 registry , 2018, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[8]  G. Niccoli,et al.  Angina after percutaneous coronary intervention: The need for precision medicine. , 2017, International journal of cardiology.

[9]  M. Mancone,et al.  Prasugrel or Ticagrelor in ST-Segment-Elevation Myocardial Infarction Patients With Diabetes Mellitus. , 2017, Circulation.

[10]  Mark W. Sheldon,et al.  Impact of ranolazine on coronary microvascular dysfunction (MICRO) study. , 2017, Cardiovascular revascularization medicine : including molecular interventions.

[11]  G. Signoriello,et al.  Coronary artery bifurcation narrowing treated by Axxess stent implantation: The CARINAX registry , 2017, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[12]  A. Sinusas,et al.  Ranolazine and Microvascular Angina by PET in the Emergency Department: Results From a Pilot Randomized Controlled Trial. , 2017, Clinical therapeutics.

[13]  A. Pichard,et al.  Frequency of Angina Pectoris After Percutaneous Coronary Intervention and the Effect of Metallic Stent Type. , 2016, The American journal of cardiology.

[14]  K. Alexander,et al.  Ranolazine in patients with incomplete revascularisation after percutaneous coronary intervention (RIVER-PCI): a multicentre, randomised, double-blind, placebo-controlled trial , 2016, The Lancet.

[15]  K. Anstrom,et al.  Effects of Ranolazine on Angina and Quality of Life After Percutaneous Coronary Intervention With Incomplete Revascularization: Results From the Ranolazine for Incomplete Vessel Revascularization (RIVER-PCI) Trial , 2016, Circulation.

[16]  I. Savelieva,et al.  Relative efficacy of antianginal drugs used as add-on therapy in patients with stable angina: A systematic review and meta-analysis , 2015, European journal of preventive cardiology.

[17]  A. Gallino,et al.  Ranolazine: Drug overview and possible role in primary microvascular angina management. , 2015, International journal of cardiology.

[18]  V. Figueredo,et al.  Update on ranolazine in the management of angina , 2014, Vascular health and risk management.

[19]  G. Rosano,et al.  Effects of ranolazine in symptomatic patients with stable coronary artery disease. A systematic review and meta-analysis. , 2013, International journal of cardiology.

[20]  Jeroen J. Bax,et al.  2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. , 2013, European heart journal.

[21]  M. Mancone,et al.  Do angle and anatomy influence outcomes in bifurcation stenting? , 2013, Minerva cardioangiologica.

[22]  B. Chaitman,et al.  Gender comparison of efficacy and safety of ranolazine for chronic angina pectoris in four randomized clinical trials. , 2007, The American journal of cardiology.

[23]  M. Jetté,et al.  Metabolic equivalents (METS) in exercise testing, exercise prescription, and evaluation of functional capacity , 1990, Clinical cardiology.