Efficacy and safety of oral l-arginine in acute myocardial infarction. Results of the multicenter, randomized, double-blind, placebo-controlled ARAMI pilot trial.
OBJECTIVE
L-arginine is a substrate for nitric oxide (NO) synthesis in vascular endothelial cells. NO bioavailability is decreased during myocardial infarction (MI). It might be expected that administration of L-arginine may maintain NO production and alleviate the course of MI. The aim of the study was to assess safety and effects of treatment with L-arginine on the clinical course of MI.


RESULTS
792 patients (mean age 64 years, 551 men) with ST segment elevation MI admitted within 24h after the onset of symptoms were randomized to oral L-arginine (3.0 t.i.d p.o. for 30 days) or placebo on top of routine therapy. The end point which was the composite of 30 day cardiovascular death, reinfarction, successful resuscitation, shock/pulmonary edema or recurrent myocardial ischemia occurred in 24% patients treated with L-arginine and 27% with placebo (OR 0.63, 95% CI 0.39-1.02, p=0.06). The end point was observed less frequently in 226 patients with hyperlipidemia (19 vs 31, p<0.05). No serious adverse effects were observed during L-arginine supplementation.


CONCLUSIONS
This study, which is the first attempt to use L-arginine in MI, showed that oral L-arginine supplementation was well tolerated. Beneficial nonsignificant trend was observed towards reduction of major clinical events.
Bednarz
Bronisław
B
Postgraduate Medical School, Department of Cardiology, Grochowski Hospital, Warsaw.
Jaxa-Chamiec
Tomasz
T
Maciejewski
Paweł
P
Szpajer
Michał
M
Janik
Krzysztof
K
Gniot
Jacek
J
Kawka-Urbanek
Teresa
T
Drozdowska
Dorota
D
Gessek
Jacek
J
Laskowski
Henryk
H
D000284:Administration, Oral; D000368:Aged; D001120:Arginine / Q000008:administration & dosage* / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D006329:Heart Conduction System; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000378:metabolism; D009569:Nitric Oxide / Q000378:metabolism*; D010865:Pilot Projects; D016896:Treatment Outcome
D009569:Nitric Oxide; D001120:Arginine