VALsartan In Acute myocardial iNfarcTion (VALIANT) trial: baseline characteristics in context

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Abstract
1 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). 2 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. 3 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. 4 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.

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