International journal of cardiology · 2026
Association between Ranolazine use and outcomes in patients with suspected MINOCA: A propensity-matched cohort study.
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Wu Jheng-Yan, Lee Keng-Wei, Huang Sheng-Chi, Chang Hsuan-Yuan, Lin Yu-Min
Аннотация
BACKGROUND: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous clinical syndrome with limited evidence to guide secondary prevention. Ranolazine, a selective inhibitor of the late sodium current, improves coronary microvascular function and angina symptoms, yet its long-term prognostic value in MINOCA remains unclear.
OBJECTIVES: To assess the association between ranolazine use and the risk of a composite outcome of all-cause mortality and heart failure exacerbation (HFE) in patients with MINOCA.
METHODS: We conducted a retrospective cohort study using the TriNetX global health network, encompassing approximately 178 million patients from 156 healthcare organizations. Adults (≥18 years) diagnosed with suspected MINOCA identified based on administrative diagnostic coding between 2006 and 2025 were included. Patients treated with ranolazine were compared with non-users using 1:1 propensity score matching. The primary endpoint was a composite of all-cause mortality and HFE. Secondary endpoints included the individual components of the composite outcome.
RESULTS: Among 951,660 eligible patients, 2965 received ranolazine. After matching, 5930 balanced patients were analyzed. Ranolazine use was associated with a lower 3-year risk of the composite outcome (28.0% vs. 31.4%; HR 0.87, 95% CI 0.80-0.96; P = 0.005), mainly driven by fewer HFE (16.1% vs. 18.9%; HR 0.84, 95% CI 0.75-0.95; P = 0.006). All-cause mortality showed a nonsignificant trend toward benefit (HR 0.93; P = 0.26). Subgroup and sensitivity analyses supported result robustness.
CONCLUSIONS: In this real-world propensity-matched cohort, ranolazine use was associated with a significantly lower risk of the composite outcome of all-cause mortality and HFE, primarily driven by a reduction in HFE, suggesting potential prognostic benefits beyond symptom relief in MINOCA.
OBJECTIVES: To assess the association between ranolazine use and the risk of a composite outcome of all-cause mortality and heart failure exacerbation (HFE) in patients with MINOCA.
METHODS: We conducted a retrospective cohort study using the TriNetX global health network, encompassing approximately 178 million patients from 156 healthcare organizations. Adults (≥18 years) diagnosed with suspected MINOCA identified based on administrative diagnostic coding between 2006 and 2025 were included. Patients treated with ranolazine were compared with non-users using 1:1 propensity score matching. The primary endpoint was a composite of all-cause mortality and HFE. Secondary endpoints included the individual components of the composite outcome.
RESULTS: Among 951,660 eligible patients, 2965 received ranolazine. After matching, 5930 balanced patients were analyzed. Ranolazine use was associated with a lower 3-year risk of the composite outcome (28.0% vs. 31.4%; HR 0.87, 95% CI 0.80-0.96; P = 0.005), mainly driven by fewer HFE (16.1% vs. 18.9%; HR 0.84, 95% CI 0.75-0.95; P = 0.006). All-cause mortality showed a nonsignificant trend toward benefit (HR 0.93; P = 0.26). Subgroup and sensitivity analyses supported result robustness.
CONCLUSIONS: In this real-world propensity-matched cohort, ranolazine use was associated with a significantly lower risk of the composite outcome of all-cause mortality and HFE, primarily driven by a reduction in HFE, suggesting potential prognostic benefits beyond symptom relief in MINOCA.