VALsartan In Acute myocardial iNfarcTion (VALIANT) trial: baseline characteristics in context.
BACKGROUND
The VALsartan In Acute myocardial iNfarcTion (VALIANT) trial compared outcomes with: (1) angiotensin-converting enzyme inhibition (ACEI) with the reference agent captopril; (2) angiotensin-receptor blockade (ARB) with valsartan; or (3) both in patients with heart failure (HF) and/or left ventricular systolic dysfunction (LVSD) after myocardial infarction (MI).


OBJECTIVE
a goal of this active-control trial was to simulate conditions that would lead current practitioners to use ACEIs. Thus, we compared characteristics of VALIANT patients with those of patients in placebo-controlled trials that established ACEIs as standard treatment.


RESULTS
We collected demographic, clinical, medication and imaging information from 14703 patients in 24 countries. This high-risk population was a median 65.8 years old, and 31.1% were female. Most (51.8%) showed imaging evidence of LVSD at enrollment. Most (72%) had Killip class>/=II HF. Patients received evidence-based therapies at rates similar to those of contemporary MI trials and at an improved rate compared with prior placebo-controlled ACEI trials.


CONCLUSIONS
VALIANT represents the largest globally representative cohort enrolled with HF and/or LVSD after MI. Patients were similar to those in placebo-controlled ACEI trials while reflecting improvements in evidence-based care. With enrollment complete, VALIANT is poised to define the optimal strategy for renin-angiotensin system blockade after MI to improve cardiovascular outcomes.
Velazquez
Eric J
EJ
Division of Cardiology, Department of Medicine, Duke University Medical Center and the Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27715, USA. velaz002@mc.duke.edu
Pfeffer
Marc A
MA
McMurray
John V
JV
Maggioni
Aldo P
AP
Rouleau
Jean Lucien
JL
Van de Werf
Frans
F
Kober
Lars
L
White
Harvey D
HD
Swedberg
Karl
K
Leimberger
Jeffrey D
JD
Gallo
Paul
P
Sellers
Mary Ann
MA
Edwards
Susan
S
Henis
Marc
M
Califf
Robert M
RM
D000368:Aged; D057911:Angiotensin Receptor Antagonists; D002216:Captopril / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D005987:Glyceraldehyde-3-Phosphate Dehydrogenases / Q000627:therapeutic use; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000188:drug therapy*; D010446:Peptide Fragments / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D013777:Tetrazoles / Q000627:therapeutic use*; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use*; D000068756:Valsartan; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy
D057911:Angiotensin Receptor Antagonists; D010446:Peptide Fragments; D013777:Tetrazoles; C068142:glyceraldehyde 3-phosphate dehydrogenase (304-313); D000068756:Valsartan; D002216:Captopril; D005987:Glyceraldehyde-3-Phosphate Dehydrogenases; D014633:Valine