Chronic stable angina treatment newer antianginal agents
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Chronic stable angina Microchapters | ||
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Classification | ||
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Differentiating Chronic Stable Angina from Acute Coronary Syndromes | ||
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Diagnosis | ||
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Alternative Therapies for Refractory Angina | ||
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Discharge Care | ||
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Guidelines for Asymptomatic Patients | ||
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Editors-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Cafer Zorkun, M.D., Ph.D. [2]; Associate Editors-In-Chief: John Fani Srour, M.D.; Jinhui Wu, MD
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.
Ranolazine
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.
- 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:
- 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.
References
- ↑ 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
- ↑ 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
- ↑ 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
- ↑ 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