BACKGROUND: Ranolazine is a new antianginal drug that reduces intracellular 
sodium and calcium accumulation during ischemia, thus potentially limiting 
myocardial ischemia. It remains unknown, however, if the drug can play a role in 
the pathophysiology of periprocedural myocardial infarction. The aim of this 
study was to verify in a randomized study if pretreatment with ranolazine before 
percutaneous coronary intervention (PCI) has any protective effect on 
periprocedural myocardial damage.
METHODS: Seventy patients with stable angina (age 62 ± 18 years, 42 men) 
scheduled for elective coronary intervention entered a randomized, double-blind, 
placebo-controlled pilot trial. For 7 days before the procedure, 35 patients 
were assigned to receive ranolazine (1,000 mg twice daily) and 35 patients had 
placebo. Creatine kinase-MB and troponin I levels were measured at baseline and 
at 8 and 24 hours postprocedure.
RESULTS: Comparison between the 2 groups did not show any difference in clinical 
features, extent of coronary artery disease, and technical aspects of PCI. 
Periprocedural myocardial infarction (ie, postprocedural increase of creatine 
kinase-MB ≥ 3 times above the upper limit of normal) was less commonly seen 
after PCI in the ranolazine than in the placebo group (6% vs 22%, P = .041). 
Detection of markers of myocardial injury above the upper limit of normal was 
less common [corrected] in the ranolazine vs placebo group: 23% vs 40% for 
creatine kinase-MB (P = .010) and 31% vs 48% for troponin I (P = .011). 
[corrected] Postprocedural peak markers levels were also significantly lower in 
the ranolazine vs placebo group (creatine kinase-MB: 3.1 ± 15.0 and 7.7 ± 19.1 
ng/mL, P < .05; troponin I: 0.15 ± 0.35 and 0.47 ± 0.49 ng/mL, P < .05). No 
significant adverse effect was reported by the 2 groups of patients.
CONCLUSIONS: Pretreatment with ranolazine 1,000 mg twice daily for 7 days 
significantly reduced procedural myocardial injury in elective PCI.