In a nutshell
This study aimed to compare the effectiveness and cost of ranolazine compared to other anti-angina drugs. The main finding of the study was that ranolazine users had lower rates of coronary artery bypass grafting (CABG) and overall hospitalizations, but higher rates of percutaneous coronary intervention (PCI) and hospitalizations due to heart problems, with similar costs.
Some background
Acute coronary syndrome (ACS) is a term used to describe a group of conditions that include heart attacks and unstable angina. Heart attacks are when there is a full blockage of one of the blood vessels that deliver blood to the heart. Unstable angina is when there is a partial blockage. It can become fully blocked when the blood vessel spasms. The treatment for ACS is PCI. This is where a catheter is put into the blood vessel in the arm or leg and fed to the heart where it unblocks the blocked blood vessel. Another treatment option is a coronary artery bypass graft (CABG) where a blood vessel is taken from the arm or leg and used to redirect blood flow around the blockage.
Stable angina is chest pain during exercise due to a partial blockage in a blood vessel to the heart. Stable angina is treated with anti-anginal drugs (nitrates, calcium channel blockers, and b-blockers). These drugs cause the blood vessels to the heart to become wider to increase blood flow. Ranolazine (Ranexa) is also an anti-angina drug that works in a different way. Patients with stable angina are at risk of ACS.
It is unknown how effective ranolazine is compared to other anti-angina drugs in preventing ACS and in cost.
Methods & findings
This study included 37,060 veterans with stable angina. Patients were either treated with ranolazine or other anti-anginal drugs.
At 8-year follow up, there was a 16% higher rate of PCI in patients who were treated with ranolazine compared to other drugs. However, there was an 18% lower risk of CABG in ranolazine-treated patients. There were 6% less overall hospitalizations in ranolazine-treated patients. However, there were 13% more hospitalizations due to ACS in patients treated with ranolazine compared to patients treated with other anti-anginal drugs. There was no difference in 1-year costs between the two groups.
The bottom line
The authors concluded that patients treated with ranolazine had lower rates of CABG and overall hospitalizations but a higher risk of PCI and ACS.
The fine print
This study received support from Gilead Sciences, the developer of ranolazine.
Published By :
The American journal of cardiology
Date :
Dec 01, 2018
