Oral L-arginine supplementation in acute myocardial infarction therapy: a meta-analysis of randomized controlled trials.
OBJECTIVE
The objective was to analyze completed trials assessing the effect of oral L-arginine supplementation on clinical outcomes of patients with acute myocardial infarction (AMI).


BACKGROUND
Prior trials suggest that oral L-arginine administration improves endothelial function in patients with stable coronary artery disease (CAD). However, it is still unclear whether oral supplementation of L-arginine has any effect on clinical outcomes in patients with unstable CAD, such as AMI.


METHODS
We systematically searched PubMed, Cochrane Library, Embase, reviews, and reference lists of relevant articles. The search strategy paired the term "arginine" with the following: "coronary heart disease," "myocardial infarction," "cardiovascular disease," "ischemia," and "trial." We conducted a meta-analysis of randomized, placebo-controlled L-arginine supplementation trials that evaluated clinical outcomes in AMI patients. Two reviewers independently assessed the trials. Differences were resolved by consensus.


RESULTS
Only 2 trials (927 participants) were included. None of the 2 studies showed a significant difference in event rate between the L-arginine and placebo groups. In an overall pooled estimate, there was a 7% reduction in mortality in the L-arginine treatment group (105/459, 22.9%) compared with the control group (111/455, 24.4%), which did not reach statistical significance (risk ratio [RR]: 0.93, 95% confidence interval [CI]: 0.74-1.17; P = 0.54).


CONCLUSIONS
Oral L-arginine supplementation has no effect on the clinical outcomes of patients with AMI.
Sun
Tao
T
Department of Cardiology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai 200040, P.R. China.
Zhou
Wen-Bai
WB
Luo
Xin-Ping
XP
Tang
Yao-Liang
YL
Shi
Hai-Ming
HM
D000284:Administration, Oral; D001120:Arginine / Q000008:administration & dosage*; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D004311:Double-Blind Method; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D002317:Cardiovascular Agents; D001120:Arginine