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New page: __NOTOC__ {{Chronic stable angina}} '''Editors-In-Chief:''' C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; {{CZ}}; '''Associate Editors-In-Chief:''' [[J...
 
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__NOTOC__
{{Chronic stable angina}}
{{Chronic stable angina}}
'''Editors-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; {{CZ}}; '''Associate Editors-In-Chief:''' [[John Fani Srour, M.D.]]; Jinhui Wu, MD
'''EditoR-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:mgibson@perfuse.org] Phone:617-632-7753; '''Associate Editor(s)-In-Chief:''' {{CZ}}; [[John Fani Srour, M.D.]]; Jinhui Wu, M.D.
 
==Overview==
*'''[[Ranolazine]]''' is a one of the newer FDA approved anti-anginal medication for the use for chronic angina.


==Newer Anti-Anginal Agents==
*'''[[Ranolazine]]''' is a one of the newer anti-anginal medications. It has been FDA approved for the use for chronic angina.
*Another anti-anginal which has primarily been used in Australia and New Zealand is '''Perhexiline''' is being studied for use in United States and UK.
*Another anti-anginal which has primarily been used in Australia and New Zealand is '''Perhexiline''' is being studied for use in United States and UK.


==Ranolazine==
==Mechanisms of benefit==
'''Mechanism of benefit:'''
*[[Ranolazine]] is believed to have its effects via altering the trans-cellular late sodium current, which remains open in pathologic states such as [[ischemia]] and [[heart failure]].  
*[[Ranolazine]] is believed to have its effects via altering the trans-cellular late sodium current, which remains open in pathologic states such as [[ischemia]] and [[heart failure]].  
*It is understood that persistent opening of these late sodium channel leads to intracellular sodium overload and, consequently, intracellular calcium overload and increased diastolic stiffness, thereby, leading to compression of the intramural vessels that supply the myocardium with blood and oxygen. Thus, inhibition of this effect results in improvement of [[ischemia]] and anginal symptoms.  
*It is understood that persistent opening of these late sodium channel leads to intracellular sodium overload and, consequently, intracellular calcium overload and increased diastolic stiffness, thereby, leading to compression of the intramural vessels that supply the myocardium with blood and oxygen. Thus, inhibition of this effect results in improvement of [[ischemia]] and anginal symptoms.  


'''Clinical trial data:'''
==Supportive trial data==
*It has been studied for use as both monotherapy <ref name="pmid15093870">Chaitman BR, Skettino SL, Parker JO, Hanley P, Meluzin J, Kuch J et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15093870 Anti-ischemic effects and long-term survival during ranolazine monotherapy in patients with chronic severe angina.] ''J Am Coll Cardiol'' 43 (8):1375-82. [http://dx.doi.org/10.1016/j.jacc.2003.11.045 DOI:10.1016/j.jacc.2003.11.045] PMID: [http://pubmed.gov/15093870 15093870]</ref> and combination therapy. <ref name="pmid14734593">Chaitman BR, Pepine CJ, Parker JO, Skopal J, Chumakova G, Kuch J et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14734593 Effects of ranolazine with atenolol, amlodipine, or diltiazem on exercise tolerance and angina frequency in patients with severe chronic angina: a randomized controlled trial.] ''JAMA'' 291 (3):309-16. [http://dx.doi.org/10.1001/jama.291.3.309 DOI:10.1001/jama.291.3.309] PMID: [http://pubmed.gov/14734593 14734593]</ref> Both these trials met their primary endpoint, which was evidence of improved exercise tolerance in patients with angina treated with ranolazine versus placebo.  
*It has been studied for use as both monotherapy <ref name="pmid15093870">Chaitman BR, Skettino SL, Parker JO, Hanley P, Meluzin J, Kuch J et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15093870 Anti-ischemic effects and long-term survival during ranolazine monotherapy in patients with chronic severe angina.] ''J Am Coll Cardiol'' 43 (8):1375-82. [http://dx.doi.org/10.1016/j.jacc.2003.11.045 DOI:10.1016/j.jacc.2003.11.045] PMID: [http://pubmed.gov/15093870 15093870]</ref> and combination therapy.<ref name="pmid14734593">Chaitman BR, Pepine CJ, Parker JO, Skopal J, Chumakova G, Kuch J et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=14734593 Effects of ranolazine with atenolol, amlodipine, or diltiazem on exercise tolerance and angina frequency in patients with severe chronic angina: a randomized controlled trial.] ''JAMA'' 291 (3):309-16. [http://dx.doi.org/10.1001/jama.291.3.309 DOI:10.1001/jama.291.3.309] PMID: [http://pubmed.gov/14734593 14734593]</ref> Both these trials met their primary endpoint, which was evidence of improved exercise tolerance in patients with angina treated with ranolazine versus placebo.  
 
*MERLIN TIMI 36 trial <ref name="pmid17804441">Scirica BM, Morrow DA, Hod H, Murphy SA, Belardinelli L, Hedgepeth CM et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17804441 Effect of ranolazine, an antianginal agent with novel electrophysiological properties, on the incidence of arrhythmias in patients with non ST-segment elevation acute coronary syndrome: results from the Metabolic Efficiency With Ranolazine for Less Ischemia in Non ST-Elevation Acute Coronary Syndrome Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36) randomized controlled trial.] ''Circulation'' 116 (15):1647-52. [http://dx.doi.org/10.1161/CIRCULATIONAHA.107.724880 DOI:10.1161/CIRCULATIONAHA.107.724880] PMID: [http://pubmed.gov/17804441 17804441]</ref> and its substudy<ref name="pmid19389561">Wilson SR, Scirica BM, Braunwald E, Murphy SA, Karwatowska-Prokopczuk E, Buros JL et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19389561 Efficacy of ranolazine in patients with chronic angina observations from the randomized, double-blind, placebo-controlled MERLIN-TIMI (Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Segment Elevation Acute Coronary Syndromes) 36 Trial.] ''J Am Coll Cardiol'' 53 (17):1510-6. [http://dx.doi.org/10.1016/j.jacc.2009.01.037 DOI:10.1016/j.jacc.2009.01.037] PMID: [http://pubmed.gov/19389561 19389561]</ref> is the most recent development in relation to this drug. In this randomized, double-blind, placebo-controlled trial of 6560 patients with [[ACS]], ranolazine not only showed inmproved anti-ischemic effects in the 3565 patients with prior chronic stable angina, but also showed anti-arrythmic effects with decrease incidence of [[ventricular tachycardia]], [[SVT]] and ventricular pauses in ranolazine study group.
 
==Vote on and Suggest Revisions to the Current Guidelines==
*[[The Living Guidelines: Chronic Stable Angina Pectoris | The Chronic Stable Angina Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines]]
 
==Sources==
*Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology <ref name="pmid16735367">{{cite journal| author=Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F et al.| title=Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology. | journal=Eur Heart J | year= 2006 | volume= 27 | issue= 11 | pages= 1341-81 | pmid=16735367 | doi=10.1093/eurheartj/ehl001 | pmc= |url=url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 [http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-angina-FT.pdf]}} </ref>
 
*The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid10351980">Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10351980 ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina).] ''Circulation'' 99 (21):2829-48. [http://circ.ahajournals.org/content/99/21/2829.full.pdf] PMID: [http://pubmed.gov/10351980 10351980]</ref>
 
*TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina <ref name="pmid12515758">Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=12515758 ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina).] ''Circulation'' 107 (1):149-58.[http://content.onlinejacc.org/cgi/reprint/41/1/159.pdf] PMID: [http://pubmed.gov/12515758 12515758]</ref>


*MERLIN TIMI 36 trial <ref name="pmid17804441">Scirica BM, Morrow DA, Hod H, Murphy SA, Belardinelli L, Hedgepeth CM et al. (2007) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17804441 Effect of ranolazine, an antianginal agent with novel electrophysiological properties, on the incidence of arrhythmias in patients with non ST-segment elevation acute coronary syndrome: results from the Metabolic Efficiency With Ranolazine for Less Ischemia in Non ST-Elevation Acute Coronary Syndrome Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36) randomized controlled trial.] ''Circulation'' 116 (15):1647-52. [http://dx.doi.org/10.1161/CIRCULATIONAHA.107.724880 DOI:10.1161/CIRCULATIONAHA.107.724880] PMID: [http://pubmed.gov/17804441 17804441]</ref> and its substudy <ref name="pmid19389561">Wilson SR, Scirica BM, Braunwald E, Murphy SA, Karwatowska-Prokopczuk E, Buros JL et al. (2009) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19389561 Efficacy of ranolazine in patients with chronic angina observations from the randomized, double-blind, placebo-controlled MERLIN-TIMI (Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Segment Elevation Acute Coronary Syndromes) 36 Trial.] ''J Am Coll Cardiol'' 53 (17):1510-6. [http://dx.doi.org/10.1016/j.jacc.2009.01.037 DOI:10.1016/j.jacc.2009.01.037] PMID: [http://pubmed.gov/19389561 19389561]</ref> is the most recent development in relation to this drug. In this randomized, double-blind, placebo-controlled trial of 6560 patients with [[ACS]], ranolazine not only showed inmproved anti-ischemic effects in the 3565 patients with prior chronic stable angina, but also showed anti-arrythmic effects with decrease incidence of [[ventricular tachycardia]], [[SVT]] and ventricular pauses in ranolazine study group.
*The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina <ref name="pmid17998462">Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)[http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=17998462 2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina.] ''Circulation'' 116 (23):2762-72.[http://content.onlinejacc.org/cgi/reprint/50/23/2264.pdf] PMID: [http://pubmed.gov/17998462 17998462]</ref>


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Revision as of 18:21, 22 August 2011

Chronic stable angina Microchapters

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EditoR-In-Chief: C. Michael Gibson, M.S., M.D. [5] Phone:617-632-7753; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [6]; John Fani Srour, M.D.; Jinhui Wu, M.D.

Overview

  • Ranolazine is a one of the newer FDA approved anti-anginal medication for the use for chronic angina.
  • Another anti-anginal which has primarily been used in Australia and New Zealand is Perhexiline is being studied for use in United States and UK.

Mechanisms of benefit

  • Ranolazine is believed to have its effects via altering the trans-cellular late sodium current, which remains open in pathologic states such as ischemia and heart failure.
  • It is understood that persistent opening of these late sodium channel leads to intracellular sodium overload and, consequently, intracellular calcium overload and increased diastolic stiffness, thereby, leading to compression of the intramural vessels that supply the myocardium with blood and oxygen. Thus, inhibition of this effect results in improvement of ischemia and anginal symptoms.

Supportive trial data

  • It has been studied for use as both monotherapy [1] and combination therapy.[2] Both these trials met their primary endpoint, which was evidence of improved exercise tolerance in patients with angina treated with ranolazine versus placebo.
  • MERLIN TIMI 36 trial [3] and its substudy[4] is the most recent development in relation to this drug. In this randomized, double-blind, placebo-controlled trial of 6560 patients with ACS, ranolazine not only showed inmproved anti-ischemic effects in the 3565 patients with prior chronic stable angina, but also showed anti-arrythmic effects with decrease incidence of ventricular tachycardia, SVT and ventricular pauses in ranolazine study group.

Vote on and Suggest Revisions to the Current Guidelines

Sources

  • Guidelines on the management of stable angina pectoris: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology [5]
  • The ACC/AHA/ACP–ASIM Guidelines for the Management of Patients With Chronic Stable Angina [6]
  • TheACC/AHA 2002 Guideline Update for the Management of Patients With Chronic Stable Angina [7]
  • The 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management of Patients With Chronic Stable Angina [8]

References

  1. ↑ Chaitman BR, Skettino SL, Parker JO, Hanley P, Meluzin J, Kuch J et al. (2004) Anti-ischemic effects and long-term survival during ranolazine monotherapy in patients with chronic severe angina. J Am Coll Cardiol 43 (8):1375-82. DOI:10.1016/j.jacc.2003.11.045 PMID: 15093870
  2. ↑ Chaitman BR, Pepine CJ, Parker JO, Skopal J, Chumakova G, Kuch J et al. (2004) Effects of ranolazine with atenolol, amlodipine, or diltiazem on exercise tolerance and angina frequency in patients with severe chronic angina: a randomized controlled trial. JAMA 291 (3):309-16. DOI:10.1001/jama.291.3.309 PMID: 14734593
  3. ↑ Scirica BM, Morrow DA, Hod H, Murphy SA, Belardinelli L, Hedgepeth CM et al. (2007) Effect of ranolazine, an antianginal agent with novel electrophysiological properties, on the incidence of arrhythmias in patients with non ST-segment elevation acute coronary syndrome: results from the Metabolic Efficiency With Ranolazine for Less Ischemia in Non ST-Elevation Acute Coronary Syndrome Thrombolysis in Myocardial Infarction 36 (MERLIN-TIMI 36) randomized controlled trial. Circulation 116 (15):1647-52. DOI:10.1161/CIRCULATIONAHA.107.724880 PMID: 17804441
  4. ↑ Wilson SR, Scirica BM, Braunwald E, Murphy SA, Karwatowska-Prokopczuk E, Buros JL et al. (2009) Efficacy of ranolazine in patients with chronic angina observations from the randomized, double-blind, placebo-controlled MERLIN-TIMI (Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST-Segment Elevation Acute Coronary Syndromes) 36 Trial. J Am Coll Cardiol 53 (17):1510-6. DOI:10.1016/j.jacc.2009.01.037 PMID: 19389561
  5. ↑ Fox K, Garcia MA, Ardissino D, Buszman P, Camici PG, Crea F; et al. (2006). [url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16735367 [1] "Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology"] Check |url= value (help). Eur Heart J. 27 (11): 1341–81. doi:10.1093/eurheartj/ehl001. PMID 16735367.
  6. ↑ Gibbons RJ, Chatterjee K, Daley J, Douglas JS, Fihn SD, Gardin JM et al. (1999) ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). Circulation 99 (21):2829-48. [2] PMID: 10351980
  7. ↑ Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS et al. (2003) ACC/AHA 2002 guideline update for the management of patients with chronic stable angina--summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Chronic Stable Angina). Circulation 107 (1):149-58.[3] PMID: 12515758
  8. ↑ Fraker TD, Fihn SD, Gibbons RJ, Abrams J, Chatterjee K, Daley J et al. (2007)2007 chronic angina focused update of the ACC/AHA 2002 Guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to develop the focused update of the 2002 Guidelines for the management of patients with chronic stable angina. Circulation 116 (23):2762-72.[4] PMID: 17998462


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