Ranolazine in Patients with Chronic Angina
The genuine article discussion and commentary based on articles from jack hello i’m tony to marry the editor of jack here with another edition of the genuine article and i’m sitting with dr. benjamin sarika who’s the one of the members of the timmy study group and also a consultant cardiologist at brigham and women’s hospital and we’re talking about the merlin trial
And a recent paper that resulted from that trial and jack can you refresh my memory about the merlin trial definitely the merlin trial was a trial of moderate to high risk patients with non-st elevation acute coronary syndrome we ended up enrolling 6560 patients followed him for a year and they were randomized either to the anti anginal agent renault lezyne which
Was started in hospital or placebo and the primary endpoint was cardiovascular death myocardial infarction or recurrent ischemia and we’ve showed the results of the primary analysis from about a year and a half ago but what we have just coming out in jak is the analysis of the patients who had prior angina before they actually were admitted with with their non-st
Elevation acs and it takes up about half of the patient population had a history of prior anjanette good so so in this report in jackie really dealing with just those people who had prior angina and then were admitted with acs and what was your endpoint in this trial we used the same endpoint of the primary endpoint of cardiovascular death myocardial infarction in
Recurrent ischemia but we also looked at other metrics of recurrent angina either the use or need for further intensification of anti anginal therapy we looked at worsening cardiovascular angina classification and we also did had a stress test at eight months in these patients so we looked at time two st depression time two symptom onset of their antennae during
These and so these were the additional analysis on top of of the primary clinical outcomes alright so these patients are mad prospectively the difference being the intervention of granola zine so what did you find so we found that very consistent with the overall results rinoa zine did not reduce either death or myocardial infarction compared to placebo but there
Was a statistically significant almost 30% reduction in the risk of recurrent angina with treatment with ranolazine in patients who had chronic angina before they were admitted for their not for their acs and we saw that was consistent regardless of the type of ischemia so whether it was worsening of canadian cardiovascular class there was an improvement with her
Analyzing whether it was hospitalization with unstable angina or with ekg changes there was a similar reduction with ranolazine there was also as consistent with the prior studies of ranolazine in patients with chronic angina there was a improvement in their exercise test performance with longer duration until their symptom on sets longer duration total of exercise
And longer duration until they had st depression on the ekg in the stress lab if they were treated with ranolazine that’s pretty impressive improvement about in general status how have you converted that into recommendations for the treatment of angina well i think we’re very cognizant and we are giving further data to support what are the guidelines that there
Really are two goals in the treatment of patients with chronic angina one is to reduce their risk of cardiovascular death and new myocardial infarction and ranolazine doesn’t seem to have a role in that area but the other important goal is to improve symptoms and still a lot of patients with chronic angina have persistent symptoms even if they’re on two or three
Anti anjan all agents and i think in this very broad population of patients with chronic angina we show that ranolazine is an effective anti anginal agent has a good safety profile and offers everybody another option to treat patients with chronic angina especially if they’ve had an acs in the preceding year or so yeah have you gotten a bit more aggressive with
Your acs patients or you renault lezyne even if they haven’t proven to have refractory engine no i’m still using a renault lezyne as an anti engine allegiant i think this study has highlighted the fact that a lot of patients who come in with non-st elevation acs have a lot of chronic coronary disease have persistent han gena sometimes their life is limited by
Their angina and they’re not actually that good at telling me about it until i push them and so to really become more aggressive on reducing their anginal symptoms with any of the auntie angela agents but i think this gives us more information and confidence that ranolazine can be an effective part of that medication regiment well that’s good information to have
Because i i think you really have hit on an important point that is that many of our coronary disease patients still do have angina and we haven’t found the perfect solution to that and a new drug like where no lezyne can help thanks very much for being with us and thank you for watching you you
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Inside JACC | Ranolazine in Patients with Chronic Angina By American College of Cardiology Video Archive