Nitric oxide inhibition rapidly increases blood pressure with no change in outcome in cardiogenic shock: the TRIUMPH trial.

Abstract

The TRIUMPH study, recently published in Journal of the American Medical Association, was a prospective randomized placebo-controlled trial testing the hypothesis that tilarginine (a non-specific inhibitor of nitric oxide synthase), when compared with placebo, would reduce 30-day mortality by 25% in patients with myocardial infarction complicated by refractory cardiogenic shock despite successful revascularization of the infarct-related artery. Patients received an intravenous bolus of the drug followed by 5 hours of intravenous infusion of the drug or a matching placebo. Although tilarginine increased systolic blood pressure by 5 mmHg at 2 hours, no effect on mortality was observed at 30 days. There was, however, a 6% absolute increase in 30-day mortality in the tilarginine group (48%, versus 42% in the placebo). This definitive trial gave strong indications for stopping any further trial using non-specific inhibitors of nitric oxide synthase in cardiogenic shock and possibly also in any other cardiovascular area.

• Authors: Réda Salem, Alexandre Mebazaa
• Journal: Critical care (London, England) (Crit Care) Vol. 11 Issue 3 Pg. 136 ( 2007) ISSN: 1466-609X [Electronic] England
• PMID: 17561988 (Publication Type: Journal Article, Randomized Controlled Trial)

Chemical References

• N(G)-monomethylarginine acetate
• Arginine

Topics

• Aged
• Arginine (analogs & derivatives, therapeutic use)
• Blood Pressure (drug effects)
• Dose-Response Relationship, Drug
• Humans
• Infusions, Intravenous
• Prospective Studies
• Shock, Cardiogenic (drug therapy, physiopathology)
• Treatment Outcome