Evidence Based Snapshots

The Journal of Informed Pharmacotherapy 2004;15:151.

Valsartan, Captopril, or Both in Myocardial Infarction Complicated by Heart Failure, Left Ventricular Dysfunction, or Both.


Reviewer: James McCormack, B.Sc. (Pharm), Pharm. D.
Reviewer's email address:
jmccorma@interchange.ubc.ca
Reviewer's profession/specialty:
Associate Editor, Journal of Informed Pharmacotherapy

Original Citation

Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. Pfeffer MA, McMurray JJ, Velazquez EJ, Rouleau JL, Kober L, Maggioni AP, Solomon SD, Swedberg K, Van de Werf F, White H, Leimberger JD, Henis M, Edwards S, Zelenkofske S, Sellers MA, Califf RM; Valsartan in Acute Myocardial Infarction Trial Investigators. N Engl J Med 2003;349:1893-906 PubMed Citation

Overall Study Question

These investigators compared valsartan, captopril or both in patients with heart failure following an acute myocardial infarction.

Patients

14,703 patients with an acute myocardial infarction complicated by heart failure (Class 1 - 28%, Class 2 - 48%, Class 3 - 18%, Class 4 - 6%).  The average age of the patients was 65 years and  31% were female.

Treatment

Patients were randomized in a blinded fashion to receive either valsartan (20mg PO daily increased to 160 mg PO BID), captopril (6.25mg PO daily increased up to 50 mg PO TID) or both valsartan (20mg PO daily increased to 80 mg PO BID) and captopril (6.25mg PO daily increased up to 50 mg PO TID). 

Duration

The median study duration was 25 months.

Results

There was no difference between groups in any end point. End points included death from cardiovascular causes, myocardial infarction, heart failure, resuscitation after cardiac arrest and stroke. 

Overall adverse events were 5-6% higher in the combination group.  

How does this study contribute to the drug therapy of patients with an acute myocardial infarction complicated by heart failure?

This study suggests that valsartan and captopril are equally effective in the treatment of an acute myocardial infarction complicated with heart failure and the combination of these agents is no more effective than the single agents alone. 


Copyright © 2004 by the Journal of Informed Pharmacotherapy. All rights reserved.