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.
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.
Authors: Jelena P Seferovic; Brian Claggett; Sara B Seidelmann; Ellen W Seely; Milton Packer; Michael R Zile; Jean L Rouleau; Karl Swedberg; Martin Lefkowitz; Victor C Shi; Akshay S Desai; John J V McMurray; Scott D Solomon Journal: Lancet Diabetes Endocrinol Date: 2017-03-18 Impact factor: 32.069
Authors: Sonya B Seif-Naraghi; Jennifer M Singelyn; Michael A Salvatore; Kent G Osborn; Jean J Wang; Unatti Sampat; Oi Ling Kwan; G Monet Strachan; Jonathan Wong; Pamela J Schup-Magoffin; Rebecca L Braden; Kendra Bartels; Jessica A DeQuach; Mark Preul; Adam M Kinsey; Anthony N DeMaria; Nabil Dib; Karen L Christman Journal: Sci Transl Med Date: 2013-02-20 Impact factor: 17.956
Authors: Edward Sze; Zainab Samad; Allison Dunning; Kristen Bova Campbell; Zak Loring; Brett D Atwater; Karen Chiswell; Joseph A Kisslo; Eric J Velazquez; James P Daubert Journal: J Am Coll Cardiol Date: 2018-01-23 Impact factor: 24.094
Authors: Andrew R Zullo; Melissa R Riester; Sebhat Erqou; Wen-Chih Wu; James L Rudolph; Michael A Steinman Journal: Drugs Aging Date: 2020-10 Impact factor: 3.923