The risk of sudden cardiac death in patients with non-ST elevation acute coronary syndrome and prolonged QTc interval: effect of ranolazine
| Autor: | Ewa Karwatowska-Prokopczuk, Luiz Belardinelli, Whedy Wang, Dewan Zeng, Peter J. Schwartz, Mei L Cheng |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Male
congenital hereditary and neonatal diseases and abnormalities medicine.medical_specialty Acute coronary syndrome Time Factors Ranolazine Kaplan-Meier Estimate Placebo Risk Assessment QT interval Piperazines Sudden cardiac death Electrocardiography Risk Factors Physiology (medical) Internal medicine medicine Humans cardiovascular diseases Acute Coronary Syndrome Aged Proportional Hazards Models Randomized Controlled Trials as Topic Retrospective Studies business.industry Incidence ST elevation Hazard ratio Cardiovascular Agents medicine.disease Long QT Syndrome Death Sudden Cardiac Treatment Outcome Multivariate Analysis cardiovascular system Cardiology Acetanilides Female Cardiology and Cardiovascular Medicine business TIMI circulatory and respiratory physiology medicine.drug |
| Zdroj: | EP Europace. 15:429-436 |
| ISSN: | 1532-2092 1099-5129 |
| DOI: | 10.1093/europace/eus400 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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