The majority of patients with SIHD have clinical features indicating that revascularization is unlikely to improve life expectancy or the risk of subsequent MI. For such patients, antianginal therapy and intensive treatment for risk factors are recommended before consideration of PCI or CABG to relieve symptoms. A broad range of highly effective drugs is available, including beta blockers, calcium channel blockers, long-acting nitrates, and newer agents such as ranolazine. Comparative trials among these medications are relatively few and for the most part small.420 On the basis of the available data, however, all of the classes of agents appear to be relatively similar in antianginal efficacy, and all have very acceptable profiles of safety and tolerability. Beta blockers have been shown to improve survival in patients after AMI and in patients with hypertension; they provide 24-hour coverage and have a long history of clinical use. For these reasons, the writing committee recommends these agents as first-line drugs for treating angina. In patients who do not tolerate or adequately respond to beta blockers, calcium channel blockers and/or long-acting nitrates may be substi- tuted or added. Ranolazine has been shown to inhibit the late sodium current in humans and has demonstrated lusitropic properties.421 Clinical trials have shown that this agent is comparable to other agents in alleviating angina. Although this agent has been approved by the US Food and Drug Administration (FDA) for first-line use in patients with chronic angina, the writing committee recommends that ranolazine be considered in circumstances in which beta blockers, calcium channel blockers, and nitrates are not adequately effective or are not tolerated. 4.2.1. Factors That Should Not Influence Treatment Decisions The 2 medical indications for revascularization are to prevent death and cardiovascular complications and to improve symptoms and quality of life. 