Despite being safe, anti-anginal medication Ranolazine has not been effective in reducing the risk of major cardiovascular events such as death// , heart attack or recurrent ischemia following acute coronary syndromes.

Despite advances in the treatment of acute coronary syndromes (ACS), the risk of recurrent events remains substantial. The medication ranolazine is used for patients with chronic angina, but because of an association between ranolazine and prolongation of the QT interval (a certain measurement on an electrocardiogram), there is a need for additional safety information to guide its use in patients with coronary artery disease. The effectiveness and safety of the drug had not previously been studied in patients with ACS or for secondary prevention of major cardiovascular events in patients with established coronary artery disease, according to background information in the article.

David A. Morrow, M.D., M.P.H., of Brigham and Women's Hospital and Harvard Medical School, Boston, and colleagues with the MERLIN (Metabolic Efficiency With Ranolazine for Less Ischemia in Non−ST-Elevation Acute Coronary Syndromes)-TIMI 36 trial evaluated the efficacy and safety of ranolazine as a new treatment to reduce cardiovascular death, heart attack or recurrent ischemia in moderate- to high-risk patients with non–ST-elevation (a certain pattern on an electrocardiogram) ACS. The randomized, multinational clinical trial included 6,560 patients who within 48 hours of ischemic symptoms were treated with ranolazine (initiated intravenously and followed by oral ranolazine extended-release 1,000 mg twice daily, n = 3,279) or matching placebo (n = 3,281), and followed up for a midpoint of 348 days.

The primary end point (cardiovascular death, heart attack, or recurrent ischemia) occurred in 21.8 percent of the patients in the ranolazine group, compared with 23.5 percent of the patients in the placebo group. The major secondary end poin
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