This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related letters  • Related article  • Similar articles in JAMA  Topic Collections  • Drug Therapy, Other  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: The study of tilarginine (L-N^G-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.

Elevated plasma concentration of the endogenous NOS inhibitor asymmetric dimethylarginine (ADMA) leads to the development of endothelial dysfunction and represents a novel cardiovascular risk factor and a predictor for all-cause and cardiovascular mortality.² Even minor impairment of renal function is associated with increased ADMA levels.³ Elevated levels of ADMA have also been observed in critically ill patients, in whom they are inversely associated with survival. Moreover, . . . [Full Text of this Article]

Jan T. Kielstein, MD
kielstein@yahoo.com
Medical School Hannover
Hannover, Germany

Karsten Sydow, MD
Hamburg University Heart Center
Hamburg, Germany

Thomas Thum, MD
Julius-Maximilians University
Würzburg, Germany

RELATED LETTERS

Effect of Tilarginine Acetate in Patients With Acute Myocardial Infarction and Cardiogenic Shock: The TRIUMPH Randomized Controlled Trial
The TRIUMPH Investigators
JAMA. 2007;297(15):1657-1666.
ABSTRACT | FULL TEXT  

Tilarginine in Patients With Acute Myocardial Infarction and Cardiogenic Shock
Tom Teerlink
JAMA. 2007;298(9):971-972.
EXTRACT | FULL TEXT  

Tilarginine in Patients With Acute Myocardial Infarction and Cardiogenic Shock—Reply
Robert A. Harrington, John H. Alexander, Judith S. Hochman, Harmony R. Reynolds, Vladimir Dzavik, and Frans J. Van de Werf
JAMA. 2007;298(9):972-973.
EXTRACT | FULL TEXT  

RELATED ARTICLE

Effect of Tilarginine Acetate in Patients With Acute Myocardial Infarction and Cardiogenic Shock: The TRIUMPH Randomized Controlled Trial
The TRIUMPH Investigators
JAMA. 2007;297(15):1657-1666.
ABSTRACT | FULL TEXT