Effect Of Ranolazine on prevention of PeriProcedural Myocardial Injury in Stable Angina Patients undergoing PCI

Background
Ranolazine is a novel antianginal drug and can play a role in the pathophysiology of periprocedural myocardial injury. The aim of this study was to assess, if pretreatment with ranolazine before percutaneous coronary intervention (PCI) has any protective effect on periprocedural myocardial damage.

Methods
One hundred ninty nine patients with stable angina scheduled for elective PCI were randomly assigned to receive or not to receive ranolazine (1,000 mg twice daily). Creatine kinase-MB and troponin I levels were measured at baseline and at 8 and 24 hours postprocedure.

Results
Ninty five patients in Ranolazine and one hundred four patients in control group are compared. Two groups did not show any difference in extent of coronary artery disease, technical aspects of PCI and pre procedural levels of biomarkers, the mean values of Trop I and CK-MB in periprocedural period were significantly lower in Ranolazine group (CKMB: 3.04 ± 2.90 vs 4.2±4.9 ng/mL, p = 0.036; Troponin I: 0.27±0.66 vs 0.65±0.86 ng/mL, p= 0.001). Absolute Rise in Biomarkers from baseline values were also significantly less in Ranolazine group. (CKMB: 2.1±3.1 vs 3.8±6.8 ng/ml, p = 0.025; Trop I: 0.26±0.66 vs 0.62±0.85, p = 0.001). No significant adverse effect was reported by the 2 groups of patients. On Multivariate analysis Ranolazine use was the only negative predictor correlated to the occurrence of periprocedural myocardial infarction.

Conclusions
Pretreatment with ranolazine 1,000 mg twice daily for 7 days significantly reduced procedural myocardial injury in elective PCI and favours TIMI III flow.