We found very low quality evidence showing that people with stable angina who received ranolazine as monotherapy had increased risk of presenting non-serious adverse events compared to those given placebo. We found low quality evidence indicating that people with stable angina who received ranolazine showed uncertain effect on the risk of cardiovascular death (for ranolazine given as monotherapy), all-cause death and non-fatal AMI, and the frequency of angina episodes (for ranolazine given as monotherapy) compared to those given placebo. Moderate quality evidence indicated that people with stable angina who received ranolazine showed uncertain effect on quality of life compared with people who received placebo. Moderate quality evidence also indicated that people with stable angina who received ranolazine as add-on therapy had fewer angina episodes but increased risk of presenting non-serious adverse events compared to those given placebo.

Background Stable angina pectoris is a chronic medical condition with significant impact on mortality and quality of life; it can be macrovascular or microvascular in origin. Ranolazine is a second-line anti-anginal drug approved for use in people with stable angina. However, the e ects of ranolazine for people with angina are considered to be modest, with uncertain clinical relevance. Objectives To assess the e ects of ranolazine on cardiovascular and non-cardiovascular mortality, all-cause mortality, quality of life, acute myocardial infarction incidence, angina episodes frequency and adverse events incidence in stable angina patients, used either as monotherapy or as add-on therapy, and compared to placebo or any other anti-anginal agent. Search methods We searched CENTRAL, MEDLINE, Embase and the Conference Proceedings Citation Index-Science in February 2016, as well as regional databases and trials registers. We also screened reference lists. Selection criteria Randomised controlled trials (RCTs) which directly compared the e ects of ranolazine versus placebo or other anti-anginals in people with stable angina pectoris were eligible for inclusion. Data collection and analysis Two authors independently selected studies, extracted data and assessed risk of bias. Estimates of treatment e ects were calculated using risk ratios (RR), mean di erences (MD) and standardised mean di erences (SMD) with 95% confidence intervals (CI) using a fixed-e ect model. Where we found statistically significant heterogeneity (Chi P < 0.10), we used a random-e ects model for pooling estimates. Metaanalysis was not performed where we found considerable heterogeneity (I ≥ 75%). We used GRADE criteria to assess evidence quality and the GRADE profiler (GRADEpro GDT) to import data from Review Manager 5.3 to create 'Summary of findings' tables. Main results We included 17 RCTs (9975 participants, mean age 63.3 years). We found very limited (or no) data to inform most planned comparisons. Summary data were used to inform comparison of ranolazine versus placebo. Overall, risk of bias was assessed as unclear.

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