LINCS: L-NAME (a NO synthase inhibitor) in the treatment of refractory cardiogenic shock - A prospective randomized study

Aims To evaluate the effect of L-NAME (a nitric oxide syntahse inhibitor) in the treatment of refractory cardiogenic shock. Methods and results We enrolled 30 consecutive patients with refractory cardiogenic shock (systolic blood pressure that deteriorated progressively to <100 mmHg during an acute coronary syndrome despite maximal percutaneous coronary revascularization, intra aortic balloon pump, and IV dopamine, furosemide and fluids treatment for at least 1 h, accompanied by signs of peripheral hypoperfusion). Patients were randomized to supportive care alone (n=15, control group) or to supportive care in addition to L-NAME (1 mg/Kg bolus and 1 mg/Kg/h continuous IV drip for 5 In n=15). Death at one month was 27% in the L-NAME group vs. 67% in the control group (p=0.008). Unaugmented mean arterial blood pressure at 24 h from randomization was 86 +/- 20 mmHg in the L-NAME group vs. 66 +/- 13 mmHg in the control group (p=0.004). Urine output increased at 24 h by 135 +/- 78 cc/h in the L-NAME group vs a decrease of 12 +/- 87cc/h in the control group (p<0.001). Time on IABP and time on mechanical ventilation were significantly shorter in the L-NAME group. Conclusions The results of the present study further support our previous observation that NO synthase inhibitors are beneficial in the treatment of patients with refractory cardiogenic shock. (C) 2003 Published by Elsevier Ltd on behalf of The European Society of Cardiology.