Effect of Ranolazine in Patients with Chest Pain and Normal Coronaries-A Hospital Based Study

Abstract

Introduction: There is an important role of coronary microcirculation in the clinical presentation and prognosis of patients who have typical chest pain despite normal epicardial coronary arteries (microvascular angina). Treatment of these patients is empirical because of the incomplete knowledge of its cause. Limited data has shown that ranolazine reduces angina and improves exercise performance in such patients with frequent angina. Aim: To evaluate the effect of ranolazine in patients with chest pain and normal epicardial coronaries (micro-vascular angina). Materials and Methods: Sixty-five patients with anginal symptoms with abnormal exercise stress test and normal epicardial coronaries were enrolled for the study. All participants had baseline demographic and health history questionnaires, including Seattle Angina Questionnaire (SAQ) and Duke Activity Status Index (DASI). After enrolment, patients were randomly divided into two groups. One group (group 1) was assigned to ranolazine for six weeks along with other indicated anti-anginal drugs. The other group (group 2) was assigned to anti-anginal drugs other than ranolazine. Patients were reassessed for symptomatic and functional improvement (SAQ, DASI) at six weeks. Results: Mean age of patients examined were 49.03 years in group 1 and 49.77 years in group 2. Approximately 42.9% of patients in group 1 and 40% in group 2 were male. Despite current anti-anginal therapy, patients in both the groups were symptomatic. At six weeks, 60% of patients in group 1 had angina as compared to 88.6% at baseline (p0.05). At six weeks, angina was significantly lower in group 1 as compared to group 2 (60 % vs 86.7%; p0.05). Conclusion: Ranolazine is safe and improves symptoms significantly in patients with micro-vascular angina.

Keywords

• anti-anginal drugs
• epicardial coronaries
• microvascular angina