No Triumph for Tilarginine in Mitigating Cardiogenic Shock

Nitric oxide synthase (NOS) inhibitors such as tilarginine (ArgiNOx) have been touted as a novel way to reduce mortality and morbidity from acute MI complicated by cardiogenic shock. The SHOCK-2 study showed a moderate improvement in hemodynamic parameters with tilarginine, presumably by a reduction in excess nitric oxide, but SHOCK-2 was not powered to determine tilarginine’s effect on outcomes. The manufacturer-funded TRIUMPH study was designed to investigate whether tilarginine would reduce mortality and morbidity in patients with MI who remained in cardiogenic shock after successful revascularization. Patients were randomized to either tilarginine (1.0-mg/kg IV bolus, followed by a 1.0-mg/kg/hour infusion for 5 hours) or placebo at leas…