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 h 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±87 cc/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.