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VALsartan In Acute myocardial iNfarcTion (VALIANT) trial: baseline characteristics in context
Eric J Velazquez1, Marc A Pfeffer, John V McMurray
1Division 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
Insights
The VALIANT trial compared angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-receptor blockers (ARB) in post-myocardial infarction (MI) patients. It found evidence-based therapies improved care compared to prior trials, setting the stage for optimal renin-angiotensin system blockade strategies.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- The VALsartan In Acute myocardial iNfarcTion (VALIANT) trial investigated treatments for patients post-myocardial infarction (MI) with heart failure (HF) and/or left ventricular systolic dysfunction (LVSD).
- It compared angiotensin-converting enzyme inhibition (ACEI) with captopril, angiotensin-receptor blockade (ARB) with valsartan, and combination therapy.
Purpose of the Study:
- To simulate conditions encouraging the use of ACEIs by current practitioners.
- To compare the characteristics of VALIANT trial participants with those in placebo-controlled trials that established ACEIs as standard treatment.
Main Methods:
- Collected demographic, clinical, medication, and imaging data from 14,703 patients across 24 countries.
- Characterized a high-risk population with a median age of 65.8 years, 31.1% female, 51.8% with LVSD, and 72% with Killip class II or higher HF.
Main Results:
- Patients received evidence-based therapies at rates comparable to contemporary MI trials.
- Therapy rates were improved compared to prior placebo-controlled ACEI trials.
Conclusions:
- VALIANT enrolled the largest globally representative cohort of patients with HF and/or LVSD post-MI.
- The patient population was similar to those in previous placebo-controlled ACEI trials, but with improved evidence-based care.
- The trial is positioned to determine the optimal renin-angiotensin system blockade strategy for improving cardiovascular outcomes after MI.
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.