B-Type Natriuretic Peptide and the Effect of Ranolazine in Patients With Non–ST-Segment Elevation Acute Coronary Syndromes: Observations From the MERLIN–TIMI 36 (Metabolic Efficiency With Ranolazine for Less Ischemia in Non-ST Elevation Acute Coronary–Thrombolysis In Myocardial Infarction 36) Trial

摘要: Objectives We designed a prospective evaluation of the interaction between B-type natriuretic peptide (BNP) and effect ranolazine in patients with acute coronary syndromes (ACS) as part randomized, blinded, placebo-controlled trial. Background Ranolazine is believed to exert anti-ischemic effects by reducing myocardial sodium calcium overload consequently ventricular wall stress. BNP increases response increased stress strong risk indicator ACS. Methods measured plasma all available baseline samples (n = 4,543) among non–ST-segment elevation ACS randomized or placebo MERLIN–TIMI 36 (Metabolic Efficiency With for Less Ischemia Non–ST Elevation Acute Coronary–Thrombolysis In Myocardial Infarction 36) trial followed them mean 343 days. The primary end point was composite cardiovascular death, infarction, recurrent ischemia. defined >80 pg/ml. Results Patients elevated 1,935) were at significantly higher (26.4% vs. 20.4%, p 80 pg/ml, reduced (hazard ratio [HR]: 0.79; 95% confidence interval [CI]: 0.66 0.94, 0.009). pg/ml directionally similar ischemia (HR: 0.78; CI: 0.62 0.98; 0.04) death infarction 0.83; 1.05, 0.12). There no detectable those low (p value 0.05). Conclusions Our findings indicate that may have enhanced efficacy high-risk identified BNP. biomarkers hemodynamic warrants additional investigation. Coronary Syndromes; NCT00099788)