Swapan Saha1, Tony Ete2, Manish Kapoor3, Pravin Kumar Jha2, Rinchin Dorjee Megeji2, Gaurav Kavi2, Synrang Batngen Warjri2, Animesh Mishra4. 1. Assistant Professor, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong, India. 2. Senior Resident, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong, India. 3. Associate Professor, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong, India. 4. Professor and Head, Department of Cardiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong, India.
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 (p<0.05). Similarly, scores of domains of SAQ were higher at six weeks as compared to baseline (p<0.05) except for treatment satisfaction. No improvement of DASI score and functional capacity were seen in either group at six weeks as compared to baseline (p>0.05). At six weeks, angina was significantly lower in group 1 as compared to group 2 (60 % vs 86.7%; p<0.05). Four out of five SAQ subscale score were higher in ranolazine group as compared to the other group (p<0.05). Treatment satisfaction trended lower on ranolazine group (p<0.05). There was no significant differences in DASI in the two groups (DASI score 30.59 vs 29.85, p>0.05). CONCLUSION:Ranolazine is safe and improves symptoms significantly in patients with micro-vascular angina.
RCT Entities:
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 (p<0.05). Similarly, scores of domains of SAQ were higher at six weeks as compared to baseline (p<0.05) except for treatment satisfaction. No improvement of DASI score and functional capacity were seen in either group at six weeks as compared to baseline (p>0.05). At six weeks, angina was significantly lower in group 1 as compared to group 2 (60 % vs 86.7%; p<0.05). Four out of five SAQ subscale score were higher in ranolazine group as compared to the other group (p<0.05). Treatment satisfaction trended lower on ranolazine group (p<0.05). There was no significant differences in DASI in the two groups (DASI score 30.59 vs 29.85, p>0.05). CONCLUSION:Ranolazine is safe and improves symptoms significantly in patients with micro-vascular angina.
Authors: Jessica L Mega; Judith S Hochman; Benjamin M Scirica; Sabina A Murphy; Sarah Sloan; Carolyn H McCabe; Piera Merlini; David A Morrow Journal: Circulation Date: 2010-04-12 Impact factor: 29.690
Authors: K C Wu; E A Zerhouni; R M Judd; C H Lugo-Olivieri; L A Barouch; S P Schulman; R S Blumenthal; J A Lima Journal: Circulation Date: 1998-03-03 Impact factor: 29.690
Authors: Priscilla Lamendola; Gaetano A Lanza; Antonella Spinelli; Gregory A Sgueglia; Antonio Di Monaco; Lucy Barone; Alfonso Sestito; Filippo Crea Journal: Int J Cardiol Date: 2008-12-12 Impact factor: 4.164
Authors: B Delia Johnson; Leslee J Shaw; Steven D Buchthal; C Noel Bairey Merz; Hee-Won Kim; Katherine N Scott; Mark Doyle; Marian B Olson; Carl J Pepine; Jan den Hollander; Barry Sharaf; William J Rogers; Sunil Mankad; John R Forder; Sheryl F Kelsey; Gerald M Pohost Journal: Circulation Date: 2004-06-14 Impact factor: 29.690
Authors: J A Spertus; J A Winder; T A Dewhurst; R A Deyo; J Prodzinski; M McDonell; S D Fihn Journal: J Am Coll Cardiol Date: 1995-02 Impact factor: 24.094
Authors: J C Kaski; G M Rosano; P Collins; P Nihoyannopoulos; A Maseri; P A Poole-Wilson Journal: J Am Coll Cardiol Date: 1995-03-15 Impact factor: 24.094
Authors: Thomas Kofler; Stefanie Hess; Federico Moccetti; Carl J Pepine; Adrian Attinger; Mathias Wolfrum; Stefan Toggweiler; Richard Kobza; Florim Cuculi; Matthias Bossard Journal: CJC Open Date: 2020-09-11