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Effect of nitric oxide synthase inhibition on haemodynamics and outcome of patients with persistent cardiogenic shock complicating acute myocardial infarction: a phase II dose-ranging study.

Publication ,  Journal Article
Dzavík, V; Cotter, G; Reynolds, HR; Alexander, JH; Ramanathan, K; Stebbins, AL; Hathaway, D; Farkouh, ME; Ohman, EM; Baran, DA; Prondzinsky, R ...
Published in: Eur Heart J
May 2007

AIMS: Previous studies suggested haemodynamic benefits and, possibly, mortality reduction with the use of nitric oxide synthase (NOS) inhibition in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). We assessed preliminary efficacy and safety of four doses of l-n-monomethyl-arginine (l-NMMA), a non-selective NOS inhibitor, in patients with AMI complicated by CS despite an open infarct-related artery. METHODS AND RESULTS: Patients (n = 79) were randomly assigned to a bolus and 5 h infusion of placebo or 0.15, 0.5, 1.0, or 1.5 mg/kg of l-NMMA. The primary outcome measure was absolute change in mean arterial pressure (MAP) at 2 h. Fifteen minutes after study drug initiation, mean change in MAP was -4.0 mmHg in the placebo group and 5.8 (P = 0.02), 4.8 (P = 0.02), 5.1 (P = 0.07), and 11.6 (P < 0.001) mmHg in the four l-NMMA groups, respectively (all vs. placebo). Mean change in MAP at 2 h was -0.4, 4.4, 1.8, -4.1, and 6.8 mmHg in the placebo and four l-NMMA groups, respectively (all P = NS). CONCLUSION: l-NMMA resulted in modest increases in MAP at 15 min compared with placebo but there were no differences at 2 h.

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Published In

Eur Heart J

DOI

ISSN

0195-668X

Publication Date

May 2007

Volume

28

Issue

9

Start / End Page

1109 / 1116

Location

England

Related Subject Headings

  • omega-N-Methylarginine
  • Shock, Cardiogenic
  • Nitric Oxide Synthase
  • Myocardial Infarction
  • Male
  • Infusions, Intravenous
  • Humans
  • Hemodynamics
  • Female
  • Enzyme Inhibitors
 

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Dzavík, V., Cotter, G., Reynolds, H. R., Alexander, J. H., Ramanathan, K., Stebbins, A. L., … SHould we inhibit nitric Oxide synthase in Cardiogenic shocK 2 (SHOCK-2) investigators, . (2007). Effect of nitric oxide synthase inhibition on haemodynamics and outcome of patients with persistent cardiogenic shock complicating acute myocardial infarction: a phase II dose-ranging study. Eur Heart J, 28(9), 1109–1116. https://doi.org/10.1093/eurheartj/ehm075
Dzavík, Vladimir, Gad Cotter, Harmony R. Reynolds, John H. Alexander, Krishnan Ramanathan, Amanda L. Stebbins, David Hathaway, et al. “Effect of nitric oxide synthase inhibition on haemodynamics and outcome of patients with persistent cardiogenic shock complicating acute myocardial infarction: a phase II dose-ranging study.Eur Heart J 28, no. 9 (May 2007): 1109–16. https://doi.org/10.1093/eurheartj/ehm075.
Dzavík V, Cotter G, Reynolds HR, Alexander JH, Ramanathan K, Stebbins AL, Hathaway D, Farkouh ME, Ohman EM, Baran DA, Prondzinsky R, Panza JA, Cantor WJ, Vered Z, Buller CE, Kleiman NS, Webb JG, Holmes DR, Parrillo JE, Hazen SL, Gross SS, Harrington RA, Hochman JS, SHould we inhibit nitric Oxide synthase in Cardiogenic shocK 2 (SHOCK-2) investigators. Effect of nitric oxide synthase inhibition on haemodynamics and outcome of patients with persistent cardiogenic shock complicating acute myocardial infarction: a phase II dose-ranging study. Eur Heart J. 2007 May;28(9):1109–1116.
Journal cover image

Published In

Eur Heart J

DOI

ISSN

0195-668X

Publication Date

May 2007

Volume

28

Issue

9

Start / End Page

1109 / 1116

Location

England

Related Subject Headings

  • omega-N-Methylarginine
  • Shock, Cardiogenic
  • Nitric Oxide Synthase
  • Myocardial Infarction
  • Male
  • Infusions, Intravenous
  • Humans
  • Hemodynamics
  • Female
  • Enzyme Inhibitors