Valsartan in acute myocardial infarction trial

Studied population in the immediate period following acute MI or surgical revascularization. However, in direct contrast to DINAMIT, a recent substudy of VALIANT (Valsartan in Acute Myocardial Infarction Trial) found that the risk of SCD is highest in the first 30 days after MI among patients with LV dysfunction, heart failure, or both [35], Therefore, the timing of ICD implantation after MI in the setting of LV dysfunction may still be open to debate. 

Reed SD, Radeva Jl, Weinfurt KP, McMurray JJV, Pfef-fer MA, Velazquez EJ et al. Resource use, costs, and quality of life among patients in the multinational Valsartan in Acute Myocardial Infarction Trial. Am Heart J 2005 150 323-9. 

Abbreviations ACE, angiotensin-converting enzyme CHARM, candesartan in heart failure assessment of reduction in mortality and morbidity ELITE, evaluation of losartan in the elderly HF, heart failure LVEF, left ventricular ejection fraction Ml. myocardial infarction NYHA. New York Heart Association OFTIMAAL. optimal trial in myocardial infarction with angiotensin II antagonist losartan Val-HeFT, valsartan in heart failure trial VALIANT, valsartan in acute myocardial infarction trial. 

Effects after myocardial infarction In patients with evidence of LV dysfunction early after myocardial infarction, the Valsartan in Acute Myocardial Infarction Trial (VALIANT) (48) demonstrated that valsartan had a benefit that was not inferior to that of ACE inhibitors without an advantage in terms of tolerability. However, the addition of an angiotensin II receptor blocker to an ACE inhibitor did not improve the outcomes and resulted in more side effects. 

In addition to its antihypertensive effects, the ARB losartan demonstrated cardiovascular benefits beyond lowering blood pressure in the Losartan Intervention for Endpoint (LIFE) Reduction in Hypertension Study [8]. Similarly, results from the Valsartan in Acute Myocardial Infarction Trial showed that valsartan improves survival after acute MI in high-risk patients [15]. Due to a lack of clinical studies involving populations with the same cardiovascular risk profile, it is not possible to extrapolate these findings to all ARBs, particularly since the dose of ARB used appears critically important [7]. Several ARBs carry additional indications, including treatment of hypertension with LVH, stroke prevention, CHF, and nephropathy in typ. 2 diabetes mellitus. 

McMurray J, Solomon S, Pieper K, Reed S, Rouleau J, Velazquez E, White H, Howlett J, Swedberg K, Maggioni A, Kober L, Van de Werf F, Califf R, Pfeffer M (2006) The effect of valsartan, captopril, or both on atherosclerotic events after acute myocardial infarction an analysis of the Valsartan in Acute Myocardial Infarction Trial (VALIANT). J Am Coll Cardiol 47 726-733... 

The Valsartan in Acute Myocardial Infarction Trial (VALIANT) compared the effects of valsartan, captopril, and the combination of the two agents in post-MI patients with symptomatic heart failure, left ventricular dysfunction, or both. The primary end point of total mortality occurred in 19.3% of patients receiving valsartan and captopril, 19.5% of captopril-treated patients, and 19.9% of the valsartan-treated group. Thus, in this high-risk post-MI population, valsartan was as effective as captopril in reducing the risk of death, but combination therapy only increased the risk of adverse effects and did not improve survival compared with monotherapy with either agent. 

Pfeffer MA, McMurray JJV, Velazquez EJ, et al. Valsartan, Captopril, or Both in Myocardial Infarction Complicated by Heart Failure, Teft Ventricular Dysfunction, or Both. Valsartan in Acute Myocardial Infarction Trial Investigators. N Engl J Med 2003 349(20) 1893-906. 

---