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【medical-news】精氨酸醋酸盐对急性心梗和心源性
The TRIUMPH Randomized Controlled Trial
RESOURCE:JAMA. 2007;297:1657-1666. Published online March 26, 2007 (doi:10.1001/jama.297.15.joc70035).
ABSTRACT:
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, renal function, and survival in patients with cardiogenic shock.
Objective To examine the effects of an isoform-nonselective NOS inhibitor in patients with MI and refractory cardiogenic shock despite establishment of an open infarct artery.
Design, Setting, and Patients International, multicenter, randomized, double-blind, placebo-controlled trial (Tilarginine Acetate Injection in a Randomized International Study in Unstable MI Patients With Cardiogenic Shock [TRIUMPH]) with planned enrollment of 658 patients at 130 centers. Participants were enrolled between January 2005 and August 2006 when the study was terminated early.
Intervention Tilarginine (L-NG-monomethylarginine [L-NMMA]), 1-mg/kg bolus and 1-mg/kg per hour 5-hour infusion, vs matching placebo.
Main Outcome Measures The primary outcome was 30-day all-cause mortality among patients who received study medication. Secondary outcomes included shock resolution and duration, New York Heart Association (NYHA) functional class at 30 days, and 6-month mortality.
Results Enrollment was terminated at 398 patients based on a prespecified futility analysis. Six-month follow-up was completed in February 2007. There was no difference in 30-day all-cause mortality between patients who received tilarginine (97/201 [48%]) vs placebo (76/180 [42%]) (risk ratio, 1.14; 95% confidence interval, 0.92-1.41; P = .24). Resolution of shock (133/201 [66%] tilarginine vs 110/180 [61%] placebo; P = .31) and duration of shock (median, 156 [interquartile range, 78-759] hours tilarginine vs 190 [100-759] placebo; P = .16) were similar. At 30 days a similar percentage of patients had heart failure (48% tilarginine vs 51% placebo; P = .51) with a similar percentage of those patients in NYHA class I/II (73% tilarginine vs 75% placebo; P = .27). After 6 months mortality rates were similar in the 2 groups (58% tilarginine vs 59% placebo; hazard ratio, 1.04; 95% confidence interval, 0.79-1.36; P = .80).
Conclusions Tilarginine, 1-mg/kg bolus and 5-hour infusion, did not reduce mortality rates in patients with refractory cardiogenic shock complicating MI despite an open infarct artery. Early mortality rates in this patient group are high. Further research is needed to develop effective therapies for patients with cardiogenic shock following acute MI. 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领 ITLE:Effect of Tilarginine Acetate in Patients With Acute Myocardial Infarction and Cardiogenic Shock
The TRIUMPH Randomized Controlled Trial
标题：精氨酸醋酸盐对急性心梗和心源性休克患者的疗效
——TRIUMPH 随机对照研究
ABSTRACT:
摘要：
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, renal function, and survival in patients with cardiogenic shock.
背景：尽管广泛应用早期血管重建术，急性心肌梗死合并心源性休克仍旧是常见的致死性疾患。全身炎症反应，包括诱生型一氧化氮合酶的表达和过多的一氧化氮的产生，被认为是心源性休克的发病机理和不适当的血管扩张的原因。初步的单中心研究表明一氧化氮合酶抑制剂对心源性休克患者的血流动力学，肾脏功能和生存率都有有益的作用。
Objective To examine the effects of an isoform-nonselective NOS inhibitor in patients with MI and refractory cardiogenic
shock despite establishment of an open infarct artery.
目的：测定一种非选择性的对碘氧基苯甲醚为成分的一氧化氮合酶抑制剂在对已施行梗塞血管再通的心肌梗塞和顽固性心源性休克患者中的 疗效。
Design, Setting, and Patients International, multicenter, randomized, double-blind, placebo-controlled trial (Tilarginine
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作者:admin@医学,生命科学 2011-02-27 17:11
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