Effect of tilarginine acetate in patients with acute myocardial infarction and cardiogenic shock: the TRIUMPH randomized controlled trial.

@article{Alexander2007EffectOT,
  title={Effect of tilarginine acetate in patients with acute myocardial infarction and cardiogenic shock: the TRIUMPH randomized controlled trial.},
  author={J. Alexander and H. Reynolds and A. Stebbins and V. Dz̆av{\'i}k and R. Harrington and F. Van de Werf and J. Hochman},
  journal={JAMA},
  year={2007},
  volume={297 15},
  pages={
          1657-66
        }
}
CONTEXT Cardiogenic shock complicating acute myocardial infarction (MI) remains a common and lethal disorder despite aggressive use of early revascularization. Systemic inflammation, including expression of inducible nitric oxide synthase (NOS) and generation of excess nitric oxide, is believed to contribute to the pathogenesis and inappropriate vasodilatation of persistent cardiogenic shock. Preliminary, single-center studies suggested a beneficial effect of NOS inhibition on hemodynamics… Expand

Paper Mentions

Interventional Clinical Trial
SENIOR-RITA is a multicentre prospective open-label trial randomizing patients presenting with type 1 NSTEMI aged ≥75 years between invasive and conservative treatment strategies, to… Expand
ConditionsNSTEMI - Non-ST Segment Elevation MI
InterventionOther, Procedure
Cardiogenic shock: The role of inflammation
TLDR
It would be reasonable to study the effects of small doses of corticosteroids and hemofiltration in patients with CS and signs of SIRS and a challenging subject of future studies will be treatment of CS with specific inhibitors of inducible isoform of NOS. Expand
Nitric oxide inhibition rapidly increases blood pressure with no change in outcome in cardiogenic shock: the TRIUMPH trial
TLDR
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. Expand
Nitric oxide synthase inhibitors in cardiogenic shock: present and future.
TLDR
The focus of this review is to describe the available data regarding NO synthase (NOS) inhibitors in CS, and major design issues regarding the optimal timing, dosing, duration and NOS inhibitor need to be addressed prior to rendering this therapy ineffective. Expand
Acute myocardial infarction and cardiogenic shock
TLDR
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TLDR
There are no robust and convincing data to support a distinct inotropic or vasodilator drug based therapy as a superior solution to reduce mortality in haemodynamically unstable patients with CS or low cardiac output complicating AMI. Expand
Expert opinion on tilarginine in the treatment of shock
TLDR
Outcome studies in these two disorders have proved disappointing and the use of a selective inducible NOS inhibitor to reduce the pathological effects of excessive NO production although leaving the beneficial effects of vascular NO production by endothelial NOS unaltered may prove to be of value. Expand
Vasoactive pharmacologic therapy in cardiogenic shock: a critical review
TLDR
A critical review was conducted to analyze the currently available randomized studies of vasoactive agents in CS to determine the indications of each agent and to critically appraise the methodological quality of the studies. Expand
[Ivabradine - a new therapeutic option for cardiogenic shock?].
TLDR
A case report of a patient with cardiogenic shock due to main trunk occlusion, where treatment with ivabradine seemed to beneficially influence the outcome is presented, as well as the mechanisms of action of ivab radine are summarized. Expand
Hemodynamic effects of levosimendan in acute myocardial infarction complicated by cardiogenic shock and high systemic vascular resistance
TLDR
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TLDR
The case will be made for viewing CS as a serious disorder with a high early death rate, but one that is treatable and that, if approached aggressively, can result in full recovery. Expand
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