PMID- 23258816
OWN - NLM
STAT- MEDLINE
DCOM- 20130812
LR  - 20151119
IS  - 1532-2092 (Electronic)
IS  - 1099-5129 (Linking)
VI  - 15
IP  - 3
DP  - 2013 Mar
TI  - The risk of sudden cardiac death in patients with non-ST elevation acute coronary 
      syndrome and prolonged QTc interval: effect of ranolazine.
PG  - 429-36
LID - 10.1093/europace/eus400 [doi]
AB  - AIMS: Clinical utility of QTc prolongation as a predictor for sudden cardiac 
      death (SCD) has not been definitely established. Ranolazine causes modest QTc 
      prolongation, yet it shows antiarrhythmic properties. We aimed to determine the 
      association between prolonged QTc and risk of SCD, and the effect of ranolazine 
      on this relationship. METHODS AND RESULTS: The relationship between baseline QTc 
      and SCD was studied in 6492 patients with non-ST elevation acute coronary 
      syndrome (NSTEACS) randomized to placebo or ranolazine in the MERLIN-TIMI 36 
      trial. In the placebo group, an abnormal QTc interval (>/=450 ms in men, >/=470 ms in 
      women) was associated with a two-fold increased risk of SCD (hazard ratio, HR, 
      2.3, P = 0.005) after adjustment for other risk factors (age >/=75 years, NYHA 
      class III/IV, high TIMI risk score, ventricular tachycardia >/=8 beats, digitalis, 
      and antiarrhythmics). In the ranolazine group, the association between abnormal 
      QTc and SCD was similar to placebo, but not significant (HR 1.8, P = 0.074). 
      There was no significant difference between placebo and ranolazine in the risk 
      for SCD in patients with abnormal QTc (HR 0.78, P = 0.48). When QTc was used as a 
      continuous variable, for every 10 ms increase in QTc, hazard rate for SCD 
      increased significantly by 8% (P = 0.007) in the placebo group, and only by 2.9% 
      (P = 0.412; P for interaction=0.25) in the ranolazine group. CONCLUSION: In 
      NSTEACS patients treated with placebo, prolonged QTc was a significant 
      independent predictor for SCD. Ranolazine, compared with placebo, was not 
      associated with increased risk for SCD in patients with prolonged QTc.
FAU - Karwatowska-Prokopczuk, Ewa
AU  - Karwatowska-Prokopczuk E
AD  - Gilead Sciences, Inc, 333 Lakeside Drive, Foster City, CA 94404, USA. 
      ewa.prokopczuk@gilead.com
FAU - Wang, Whedy
AU  - Wang W
FAU - Cheng, Mei L
AU  - Cheng ML
FAU - Zeng, Dewan
AU  - Zeng D
FAU - Schwartz, Peter J
AU  - Schwartz PJ
FAU - Belardinelli, Luiz
AU  - Belardinelli L
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20121219
PL  - England
TA  - Europace
JT  - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal 
      of the working groups on cardiac pacing, arrhythmias, and cardiac cellular 
      electrophysiology of the European Society of Cardiology
JID - 100883649
RN  - 0 (Acetanilides)
RN  - 0 (Cardiovascular Agents)
RN  - 0 (Piperazines)
RN  - A6IEZ5M406 (Ranolazine)
SB  - IM
MH  - Acetanilides/adverse effects/*therapeutic use
MH  - Acute Coronary Syndrome/complications/diagnosis/*drug therapy/physiopathology
MH  - Aged
MH  - Cardiovascular Agents/adverse effects/*therapeutic use
MH  - Death, Sudden, Cardiac/*etiology
MH  - Electrocardiography
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Kaplan-Meier Estimate
MH  - Long QT Syndrome/chemically induced/diagnosis/*etiology/physiopathology
MH  - Male
MH  - Multivariate Analysis
MH  - Piperazines/adverse effects/*therapeutic use
MH  - Proportional Hazards Models
MH  - Randomized Controlled Trials as Topic
MH  - Ranolazine
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2012/12/22 06:00
MHDA- 2013/08/13 06:00
CRDT- 2012/12/22 06:00
PHST- 2012/12/22 06:00 [entrez]
PHST- 2012/12/22 06:00 [pubmed]
PHST- 2013/08/13 06:00 [medline]
AID - eus400 [pii]
AID - 10.1093/europace/eus400 [doi]
PST - ppublish
SO  - Europace. 2013 Mar;15(3):429-36. doi: 10.1093/europace/eus400. Epub 2012 Dec 19.