To the Editor: The study of tilarginine (L-NG-monomethylarginine [L-NMMA])by the Tilarginine Acetate Injection in a Randomized InternationalStudy in Unstable MI Patients With Cardiogenic Shock (TRIUMPH) investigators1 indicates that nonspecific inhibition of nitric oxide synthase (NOS) using L-NMMA does not improve 30-day survival or 6-month mortality rate in patients with myocardial infarction (MI) complicated by cardiogenic shock. Of note is that when renal function was assessed as a continuous variable, patients with higher creatinine levels tended to have worse outcomes with L-NMMA.
Kielstein JT, Sydow K, Thum T. Tilarginine in Patients With Acute Myocardial Infarction and Cardiogenic Shock. JAMA. 2007;298(9):971–973. doi:10.1001/jama.298.9.971-a
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