title: Ranolazine for the treatment of refractory angina in a veterans population.
abstract: BACKGROUND
  Pivotal ranolazine trials did not require optimization of conventional medical therapy including coronary revascularization and antianginal drug therapy prior to ranolazine use. This case series describes the use of ranolazine for the treatment of chronic stable angina refractory to maximal medical treatment in a veterans population.
  
  
  RESULTS
  A total of 18 patients with a median age of 66 years were identified. All patients had prior percutaneous coronary intervention and/or coronary artery bypass graft surgery; 83% had three-vessel coronary artery disease, with left main disease present in 39% of patients. Prior to initiating ranolazine, antianginal use consisted of beta blockers (94%), long-acting nitrates (83%) and calcium channel blockers (61%). Median blood pressure (116.2/61.8 mmHg) and pulse (65 beats per min) were controlled. Median preranolazine angina episodes and sublingual nitroglycerin (SLNTG) doses per week were 14 and 10, respectively, with a Canadian Cardiovascular Society (CCS) angina grade of III-IV in 67% of patients. After initiation of ranolazine, median angina episodes per week and SLNTG doses used per week decreased to 0.7 and 0, respectively, with CCS grade of III-IV declining to 17%. Of the 18 subjects enrolled, 44% had complete resolution of angina episodes.
  
  
  CONCLUSIONS
  The addition of ranolazine to maximally tolerated conventional antianginal drug therapy post coronary revascularization was associated with decreases in angina episodes and SLNTG utilization and improvement in CCS angina grades. Ranolazine may provide an effective treatment option for revascularized patients with refractory angina.
authors.affiliation: Veterans Affairs North Texas Health Care System, Dallas, TX 75216, USA. shane.greene@ttuhsc.edu
authors.forename: R Shane
authors.initials: RS
authors.lastname: Greene
authors.forename: Robert M
authors.initials: RM
authors.lastname: Rangel
authors.forename: Krystal L
authors.initials: KL
authors.lastname: Edwards
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Chastain
authors.forename: Sara D
authors.initials: SD
authors.lastname: Brouse
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Alvarez
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Collins
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
mesh_terms: D000083:Acetanilides / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D060050:Angina, Stable / Q000188:drug therapy* / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000008:administration & dosage / Q000627:therapeutic use*; D000069458:Ranolazine; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014728:Veterans
chemical_list: D000083:Acetanilides; D004791:Enzyme Inhibitors; D010879:Piperazines; D000069458:Ranolazine