Ranolazine: a new antiarrhythmic agent for patients with non-ST-segment elevation acute coronary syndromes?
Charles Antzelevitch
Correspondence Masonic Medical Research Laboratory, 2150 Bleecker Street, Utica, NY 13501–1787, USA
Email ca@mmrl.edu
This article has no abstract so we have provided the first paragraph of the full text.
The MERLIN-TIMI 36 study evaluated the efficacy and safety of ranolazine during long-term treatment of patients with NSTE ACS. The study, which included cECG monitoring of 6,351 patients and led to the creation of one of the largest known Holter databases to date, concluded that ranolazine is not associated with increased incidence of all-cause mortality, sudden cardiac death, or clinically significant arrhythmias. In addition to demonstrating the safety of ranolazine, the paper by Scirica et al. reported that patients treated with this drug had significantly lower incidence of ventricular and supraventricular tachycardia. The incidence of new-onset AF was approximately 30% lower in ranolazine-treated patients, just missing statistical significance. Notably, patients at high risk for arrhythmic events also benefited from ranolazine treatment, with a 47–49% reduction in the relative risk of developing ventricular tachycardia of eight beats or more (P <0.01). This subgroup also showed a trend towards decreased sudden cardiac death at 12 months (2.7% vs 4.9%, hazard ratio 0.49; P = 0.07).
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