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). Conclusion Oral L‐arginine supplementation has no effect on the clinical outcomes of patients with AMI. Copyright © 2009 Wiley Periodicals, Inc.