Ranolazine in Chronic Stable Angina: A Systematic Review and Meta-Analysis

Chronic stable angina (CSA) significantly impairs functional capacity and quality of life (QoL), with many patients remaining symptomatic despite standard treatment. Ranolazine, a late sodium current inhibitor, is utilized as an adjunctive antianginal therapy. This systematic review and meta-analysis evaluates its efficacy and safety in adult patients with CSA. We searched major databases through April 2025 for studies comparing ranolazine to placebo or standard therapy. Efficacy outcomes included angina burden, exercise parameters, QoL, and major adverse cardiovascular events (MACE), including myocardial infarction (MI) and revascularization. Safety was assessed via adverse event incidence. Data were synthesized using random-effects meta-analysis. Sixty-nine studies were included. Ranolazine significantly improved objective exercise measures, increasing exercise duration (mean difference {MD}, 33.1 seconds; 95% confidence interval {CI}, 27.3-38.9), time to angina onset (MD, 42.8 seconds; 95% CI, 34.2-51.5), and time to 1-mm ST depression (MD, 43.2 seconds; 95% CI, 33.8-52.6). Ranolazine was associated with a reduced risk of MI (risk ratio {RR}, 0.91; 95% CI, 0.84-0.98), coronary artery bypass grafting (CABG; RR, 0.55; 95% CI, 0.35-0.86), and any revascularization such as percutaneous coronary intervention (PCI) or CABG (RR, 0.77; 95% CI, 0.64-0.91). Adverse events were more frequent in the ranolazine group (RR, 1.45; 95% CI, 1.27-1.66) but were predominantly non-serious. Ranolazine provides robust symptomatic and functional benefits in patients with CSA. It is associated with modest reductions in MI and revascularization procedures, such as PCI or CABG. The data support ranolazine as an effective therapy for patients with CSA.