Kofler Thomas, Hess Stefanie, Moccetti Federico, Pepine Carl J, Attinger Adrian, Wolfrum Mathias, Toggweiler Stefan, Kobza Richard, Cuculi Florim, Bossard Matthias
Cardiology Division, Heart Center, Luzerner Kantonsspital, Luzern, Switzerland.
Division of Cardiovascular Medicine, University of Florida, Gainesville, Florida, USA.
CJC Open. 2020 Sep 11;3(1):101-108. doi: 10.1016/j.cjco.2020.09.005. eCollection 2021 Jan.
Coronary microvascular dysfunction (CMD) is a common cause of angina and exercise intolerance in patients without obstructive coronary artery disease. The efficacy of ranolazine, a late sodium channel blocker, in patients with symptomatic obstructive coronary artery disease is well established. To evaluate the efficacy of ranolazine in CMD, we performed a systematic review and meta-analysis of randomized studies.
MEDLINE, EMBASE, Cochrane CENTRAL, and conference abstracts were searched from January 1975 to March 2020. Randomized trials evaluating ranolazine in patients with CMD were screened. Two reviewers independently extracted data and assessed study quality. End points of interest included a change in angina measured by the Seattle Angina Questionnaire (SAQ), coronary flow reserve (CFR), and clinical outcomes. Data were combined using random-effects models.
Of 836 citations, 6 randomized studies (318 patients) were included. Median follow-up was 4 weeks. When pooling the 6 trials analyzing ranolazine, we found that patients treated with ranolazine had a higher SAQ value regarding physical functioning (mean difference, 6.42; 95% confidence interval [CI], 2.41; 10.42) quality of life (10.07; 95% CI, 3.4; 16.74), and angina stability (20.14; 95% CI, 10.12; 30.17), as well as improved CFR (0.27; 95% CI, 0.09; 0.45) compared with placebo/control therapy. A high heterogeneity was observed (range , 30%-84%).
In CMD, ranolazine may be associated with improvements in CFR and some of the SAQ domains, including angina stability, physical functioning, and quality of life. However, it does not seem to beneficially impact angina frequency and treatment satisfaction. It is also unknown if it improves prognosis of afflicted patients.
冠状动脉微血管功能障碍（CMD）是无阻塞性冠状动脉疾病患者心绞痛和运动不耐受的常见原因。雷诺嗪作为一种晚期钠通道阻滞剂，在有症状的阻塞性冠状动脉疾病患者中的疗效已得到充分证实。为了评估雷诺嗪在CMD中的疗效，我们对随机研究进行了系统评价和荟萃分析。
检索1975年1月至2020年3月的MEDLINE、EMBASE、Cochrane CENTRAL和会议摘要。筛选评估雷诺嗪在CMD患者中的随机试验。两名研究者独立提取数据并评估研究质量。感兴趣的终点包括通过西雅图心绞痛问卷（SAQ）测量的心绞痛变化、冠状动脉血流储备（CFR）和临床结局。使用随机效应模型合并数据。
在836篇文献中，纳入了6项随机研究（318例患者）。中位随访时间为4周。汇总分析6项分析雷诺嗪的试验时，我们发现与安慰剂/对照治疗相比，接受雷诺嗪治疗的患者在身体功能（平均差异，6.42；95%置信区间[CI]，2.41；10.42）、生活质量（10.07；95%CI，3.4；16.74）和心绞痛稳定性（20.14；95%CI，10.12；30.17）方面的SAQ值更高，CFR也有所改善（0.27；95%CI，0.09；0.45）。观察到高度异质性（范围为30%-84%）。
在CMD中，雷诺嗪可能与CFR改善以及SAQ的某些领域改善有关，包括心绞痛稳定性、身体功能和生活质量。然而，它似乎对心绞痛频率和治疗满意度没有有益影响。它是否能改善患病患者的预后也尚不清楚。
