• Eric J Velazquez, Marc A Pfeffer, John V McMurray, Aldo P Maggioni, Jean Lucien Rouleau, Frans Van de Werf, Lars Kober, Harvey D White, Karl Swedberg, Jeffrey D Leimberger, Paul Gallo, Mary Ann Sellers, Susan Edwards, Marc Henis, Robert M Califf, and VALIANT Investigators.
• 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
• Eur. J. Heart Fail. 2003 Aug 1;5(4):537-44.

BackgroundThe 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).Aimsa 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 ResultsWe 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.ConclusionVALIANT 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.

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