© 2003 European Society of Cardiology
VALsartan In Acute myocardial iNfarcTion (VALIANT) trial: baseline characteristics in context
a Division of Cardiology, Department of Medicine, Duke University Medical Center and the Duke Clinical Research Institute 2400 Pratt Street, Durham, NC 27715, USA
b Cardiovascular Division Brigham and Women's Hospital, Boston, MA, USA
c Clinical Research Initiative in Heart Failure University of Glasgow, Glasgow, Scotland, UK
d ANMCO Research Center Florence, Italy
e Division of Cardiology University of Toronto, Toronto, ON, Canada
f Leuven Coordinating Center Leuven, Belgium
g Rigshospitalet, Copenhagen Denmark
h Green Lane Hospital Auckland, New Zealand
i Sahlgrenska Hospital Göteborg, Sweden
j Novartis Pharmaceutical Corporation East Hanover, NJ, USA
* Corresponding author. Tel.: +1-919-668-8041; fax: +1-919-668-7058 velaz002{at}mc.duke.edu
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Abstract |
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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).
Aims: 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.
Methods and 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.
Conclusion: 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.
Key Words: Angiotensin-converting enzyme • Angiotensin receptor blocker • Myocardial infarction • Left ventricular dysfunction • Heart failure • Prognosis
Received March 18, 2003; Revised July 2, 2003; Accepted July 3, 2003
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