RIVER-PCI: Ranolazine in Chronic Angina Patients With Incomplete Revascularization Post-PCI

Ranolazine did not reduce the incidences of ischemia-driven revascularization or hospitalization in chronic angina patients with incomplete revascularization following percutaneous coronary intervention (PCI), according to the results of the RIVER-PCI trial, presented Oct. 13 at TCT 2015 and simultaneously published in the Lancet.

In this multi-center, randomized, double-blind, placebo-controlled, event-driven trial, Giora Weisz, MD, FACC, et al., sought to assess the efficacy of ranolazine in reducing rates of ischemia-driven revascularization and hospitalization at one-year follow-up. According to Weisz, “RIVER-PCI is the first trial to have prospectively studied patients with incomplete revascularization after PCI and to examine the potential role of adjunctive anti-ischemic pharmacotherapy.”

The results of the study showed that while incomplete revascularization was associated with a high rate of ischemia-driven revascularization or hospitalization, ranolazine did not reduce the composite rate of these events in chronic angina patients. Further, researchers discontinued ranolazine in patients more often than the placebo due to a higher frequency of adverse events.

In response to the ineffectiveness of ranolazine, the authors of the study note that “despite contributing to a high residual SYNTAX score (the calculation of which incorporates lesion location and myocardium at risk), many of the lesions left untreated after PCI might have been of little clinical consequence, consisting of relatively small vessels supplying limited myocardium.”

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Transcatheter Cardiovascular Therapeutics, Acetanilides, Piperazines, Angina Pectoris, Hospitalization, Myocardium, Percutaneous Coronary Intervention

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