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N Engl J Med. 2003 Nov 13;349(20):1893-906. Epub 2003 Nov 10.

Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both.

Collaborators (1111)

Pffeffer M, McMurray J, Califf R, Maggioni A, Rouleau J-, Van de Werf F, Velazquez E, Aylward P, Armstrong P, Barvik S, Belenkov Y, Dalby A, Diaz R, Drexler H, Ertl G, Francis G, Hampton J, Harsanyi A, Køber L, Kvasnicka J, Mareev V, Marin-Neto J, Murin J, Myers M, Nordlander R, Opolski G, Soler-Soler J, Spac J, Stefenelli T, Sugrue D, Swedberg K, Van Gilst W, Varshavsky S, Weaver D, White H, Zannad F, Solomon S, Aguilar D, Alvarez A, Al-Taweel M, Anavekar N, Finn P, Lopez-Jimenez F, Mercier R, Pfeffer M, Lewis E, Massoom S, Manes C, Mirza A, Sampson U, Skali H, Skali N, Szummer K, Tokmakova M, Zornoff L, Mahaffety K, Bozeman T, Doletski R, Lail R, Smith M, Taylor L, Thomas B, Schulman K, Radeva J, Reed S, Weinfurt K, Leizorovicz A, Boutitie F, Cody R, Dargie H, Hennekens C, Pocock S, Ahud Guerrero RA, Albisu JP, Amuchastegui M, Avila EM, Bassani Arrieta CA, Bastianelli R, Becker C, Bono J, Bortman G, Bustamante Labarta G, Caccavo A, Caime GD, Castellanos CR, Castro H, Covelli G, Cuneo CA, Del Rio A, Fernandez A, Fernandez Cid G, Ferro Queirel E, Fuselli JJ, Garcia MA, Garcia Duran R, Garrido M, Gentile A, Gorini NU, Grancelli H, Hasbani E, Hominal MA, Hrabar AD, Leiva JE, Lopez R, Luciardi HL, Macin SM, Mariano L, Marinesco A, Martingano R, Martino GD, Marzetti EM, Mezina V, Moreno HL, Muntaner J, Nordaby R, Nul D, Orlandini AD, Parra Pavich MA, Pomposiello JC, Quijano RA, Rusculleda M, Ryba D, Sampo E, Sanchez JA, Serra CM, Sokn F, Sosa Liprandi A, Trivi M, Vallejos F, Vico M, Vita NA, Vogel D, Valmaro JA, Arnolda L, Aroney G, Aylward P, Bett N, Carroll P, Cross D, Fitzpatrick D, Garrahy P, Hill A, Horowitz J, Hunt D, Ireland M, Lane G, Lefkovits J, Leitch JW, Nelson G, Rajappa K, Rankin J, Rees D, Russell A, Singh B, Taylor R, Thomson A, Waites J, Walsh W, Eber B, Krempler FW, Kuhn P, Pichler M, Röggla G, Siostrzonek P, Stefenelli T, Bergez B, El Allaf D, Smolders W, Van de Werf F, Van Dorpe A, Vandenbossche J-, Vanneste L, Albuquerque D, Ayoub J, Bassan R, Carvalho AC, Castro LR, Coelho O, Costa FA, Esteves J, Feitosa G, Filho J, Gun C, Kerr Saraiva J, Leas P, Maia L, Marin-Neto JA, Marino R, Mesquita E, Piegas LS, Rabelo A Jr, Rassi S, Rassi A Jr, Scherr C, Spadaro J, Vaz R, Arnold M, Bedard J, Bernstein V, Bhesania T, Bonafede N, Brossoit R, Burke B, Castan R, Charles J, Cheung MT, Chua G, Costi P, Davies R, Descoings B, Desrochers D, Dhingra S, Dion D, Duchesne L, Dupuis J, Dupuis R, Ervin F, Fowlis R, Gendreau R, Germain C, Giannoccaro P, Goode E, Gossard D, Gosselin G, Goulet G, Heath J, Heath VA, Hess A, Honos G, Howlett J, Huynh T, Javier J, Kincade D, Klinke WP, Kouz S, Kwok K, Lee R, Lenis J, Lepage S, Lubelsky B, McKelvie R, Minkovitz J, Moe G, Montigny M, Nadeau R, Nitkin C, O'Kelly B, Palaic M, Parker J, Parker T, Pesant Y, Phaneuf D, Pistawaka K, Proulx G, Roux R, Rupka D, Saulnier D, Senaratne M, Sestier F, Sharma N, St Hilaire R, Stone J, Strauss H, Sussex B, Talbot P, Tremblay B, Vizel S, Warnica JW, Weigel M, Wisenberg G, Drazka J, Filipovský J, Horký K, Janský P, Kral R, Kvasnicka J, Martínek A, Spinar J, Svitil P, Agner E, Andersen HK, Angelo-Nielsen K, Asklund M, Berning J, Brøns M, Buhl J, Eliasen P, Fløgstad T, Jensen T, Klarlund K, Køber L, Kristensen KS, Kroell L, Larsen J, Lind Rasmussen S, Madsen H, Markenvard J, Mortensen B, Nielsen H, Nielsen T, Nymann Davidson A, Nyvad O, Ottesen M, Pedersen OL, Rickers H, Rokkedal J, Scheibel M, Sejersen H, Sørensen EV, Sørensen PJ, Stenteberg SE, Bareiss P, Barraine R, Battistella PD, Beaufils P, Bonneau A, Boulenc J-, Bouvier J-, Cheggour S, Citron B, Coisne D, Delahaye F, Ferriere M, Fournier C, Kahn J-, Koenig A, Laperche T, Loiselet P, Luccioni R, Martelet M, Matina D, Ouakli A, Parisot M, Pavin D, Quiret J-, Rifai A, Tran-Thanh X, Angermann CE, Bauriedel G, Bethge H, Borst M, Braun M, Drexler H, Echternach C, Engberding R, Epping J, Ertl G, Figulla H-, Gaudron P, Hambrecht R, Hanrath P, Hey D, Jany B, Karmann W, Keller HJ, Kohler B, Kreider-Stempfle HU, Maisch B, Matthes T, Münzel T, Nast HP, Nienaber C, Nitsch J, Pfeiffer D, Pieske B, Römmele U, Rupp W, Schatz R, Schultheiss H-, Senges J, Simon R, Solzbach U, Strasser RH, Tebbe U, Topp H, Unger T, Urbaszek W, von Knorre GH, von Olshausen K, Wagner J, Wirth M, Wolf MW, Csanády M, Édes I, Erdei A, Hanis B, Harsanyi A, Jánosi A, Kaló E, Kárpáti P, Kömíves S, Kutor G, Moser G, Rumi G, Simon G, Szabóki F, Tarján J, Timár S, Tóth K, Barton JJ, Crean P, Daly K, Fitzgerald D, Kearney P, Sugrue D, Alboni P, Aloisi B, Antenucci C, Bellet C, Bernardi D, Bini A, Bortolini F, Branzi A, Bugati U, Bugiardini R, Capuano V, Carrone M, Celli P, Chiesa F, Ciconte V, Corsini G, De Angelis G, Di Pasquale G, Fanelli R, Filorizzo G, Fioretti P, Grieco A, Igone G, Mafrici A, Maglia G, Mangia R, Maras P, Masani F, Mauric A, Paci A, Pettinati G, Pirani R, Raughe W, Sala L, Sibilio G, Slavich G, Soravia G, Tartarini G, Tavazzi L, Terrosu P, Trevi G, Trfimarco B, Turri M, Turrini P, Valagussa F, Vassanelli C, Volpe M, Arnold AE, Bijl M, De Milliano PA, Dunselman PH, Fels PH, Funke Küpper A, Herweijer AH, Jaarsma W, Kamp O, Koornstra HJ, Kragten JA, Kuijer PJ, Leenders CM, Liem AH, Linssen GC, Lionarons RJ, Lok DJ, Louridtz WJ, Michels HR, Muijs van de Moer WM, Nierop PR, Posma JL, Van der Burgh PH, van Kalmthout PM, van Kempen LH, van Veldhuisen DJ, Wesdorp JC, Withagen AJ, Abdul-Ghaffar N, French J, Friedlander D, Gerber I, Hamer A, Hammet C, Hedley J, Ikram H, Mann S, Matsis P, Rankin R, Scott D, White H, Wilkins G, Williams M, Wong CK, Barvik S, Dickstein K, Hoeg V, Banasiak W, Demczuk M, Dyduszynski A, Goch JH, Górny J, Janion M, Kawecka-Jaszcz K, Kopaczewski J, Loboz-Grudzien K, Ogórek G, Opolski G, Piotrowski W, Ruszkowski P, Rynkiewicz A, Sciborski R, Stopinski M, Trusz-Gluza M, Waszyrowski T, Wojciechowski D, Wrabec K, Zambrzycki J, Ananchenko V, Arutyunov G, Baluda M, Barbarash O, Belenkiy D, Belousov S, Belousov YB, Boiarkin M, Bokarev I, Charchoglian RA, Chepky DA, Chumakova G, Doschicyn V, Dovgalevsky P, Ermoshkina L, Filonenko GS, Fomin I, Fomina I, Foytanov S, Freydlina M, Glezer M, Golikov A, Goloschekin B, Gospodarenko A, Gratsiansky N, Ivanov G, Katelnitskaya L, Khrakovskaya M, Khrustalev O, Klenina I, Kostenko V, Kozlova M, Lapin O, Leontieva N, Lopatin YM, Lusov V, Markov V, Martioushov S, Martynov A, Mezentseva N, Michailov A, Mkrtchyan VR, Moiseev V, Nedogoda S, Nefedov AV, Nefedov M, Nikitin Y, Olbinskaya L, Perepech N, Rebrov A, Rogalev K, Ruda M, Shlyahto E, Shmrova V, Shpector A, Shustov S, Shwartz Y, Sidorenko B, Simonenko V, Sobolev K, Sorokin L, Stefanenko M, Stepura O, Striouk R, Sulimov V, Sumin A, Syrkin A, Tankhilevitch B, Tarasov N, Tchutchalin A, Troshina E, Tuev AV, Vaniev S, Vertkin A, Vishnevsky A, Yacushin S, Yarokhno N, Zadiontchenko V, Zborovsky A, Zemtsovsky E, Zverev D, Brunclik P, Duris T, Hasilla J, Kohn R, Kovár F, Murin J, Renker B, Rybar R, Slanina M, Uhliar R, Bennet JM, Dalby AJ, Duncan DI, Essop MR, Kok A, Manga P, Posen BM, Roos JS, Synders FA, Steingo L, Bardají Ruiz A, Bayón Fernández J, Cruz Fernández JM, Galve Basilio E, de Miguel Díaz M, Roig Minguell E, Saenz Cusi L, Valle Tudela V, Velasco JA, Ahremark U, Aström L, Boman K, Brunmark P, Dahlström U, Fredholm O, Frisell JE, Hardhammar P, Hartford M, Hurtig M, Jonasson L, Klintberg L, Larsson L-, Nicol P, Nilsson S-, Õhlin H, Ohlsson Å, Perk J, Perrson H, Peterson M, Rasmanis G, Ringquist C, Stenberg A, Swedburg K, Ticic D, Timberg I, Waern Bugge K, Wodlin P, Adgey J, Al-Khoffash M, Andrews R, Avery P, Ball S, Baxter R, Been M, Birkhead J, Bridges A, Broadhurst P, Canepa Anson R, Cleland J, Clifford P, Connelly D, Crake T, Davies J, Davies M, Dhawan J, Dunn F, Findlay I, Hampton J, Hanley S, Higham P, Jacob A, Jones C, Kaski J, Lip G, MacFadyen R, Mattu R, McAlpine H, McMurray J, Metcalfe M, Moriarty A, Morley C, Murdoch D, Mushahwar S, Penny W, Pitcher D, Puri S, Purvis J, Ramsey M, Reid C, Richardson G, Rowlands D, Saltissi S, Senior R, Shahi J, Smith L, Spyrou N, Squire I, Stephens J, Swan J, Travill C, Uren N, Vincent R, Wheeldon N, Acheatel R, Ackell P, Adler D, Akosah K, Amidi M, Amsterdam P, Anand I, Anderson J, Aranda J, Ashar R, Ayala K, Badger R, Balk M, Bannon P, Basnight M, Battles V, Bayron C, Becker J, Belkin R, Bellamy B, Belllinger R, Bengtson J, Bennett S, Bhalodkar N, Bhat G, Birkhead R, Bittl J, Boland M, Book W, Brachfeld C, Broderick G, Brodsky M, Brown C 3rd, Bruns D, Butler J, Calnon D, Calvin J, Camacho A, Cambier P, Camp A, Campbell P, Cannon JD Jr, Cansino S, Carlson R, Carr K, Casale P, Chadow H, Chalasani P, Chandna H, Chapman D, Charlton G, Cheirif J, Childs D, Chin J, Chu A, Churchill D, Clark L, Cobb F, Colfer H, Corder C, Croitoru M, Cullinane D, Cunningham M, Dauber I, Davis T, Dawley D, Deedwania P, Delemos J, DeLeon A, Dennish G, Denny DM, Desai S, D'Haem C, Dhruva N, Dionisopoulos P, Dixon E, Dodin E, Dohad S, Dowdy D, Drury J, Duvernoy C, Edin A, Edwards T, Eelani F, El Shahawy M, Ellstad M, Ensley RD, Fahey F, Farahi J, Farnham J, Fattal P, Fernandez J, Fialkow J, Figueredo V, Fintel D, Fishbein G, Fishberg R, Fisher B, Fitzpatrick P, Flaker G, Foster M, French W, Frey M, Friedman B, Furiasse J, George J, Ghali J, Gilbert J, Giles P, Glassman J, Gleva M, Glynn R, Goldman S, Goldner D, Goodfield P, Gordon D, Gottdeiner J, Goulah R, Grady T, Graf R, Graham B, Graziano J, Gredler F, Greenberg D, Greenspan M, Gros B, Hall J Jr, Hanley H, Harris B, Harris K, Hartman C, Hashimi MW, Hassett A, Haught WH, Hill D, Hillert M, Hochman J, Hodsden J, Hoffman J, Honan M, Hsi D, Hudson M, Ingersoll H, Israel N, Jackman D, Jackson B, Jafri S, Jain A, Jamal N, Jenkins L, Jennison S, Jones M, Joseph J, Josephson R, Kannam J, Karamali A, Karns R, Katz W, Kereiakes D, Kerut EK, Kesselbrenner M, Kieval J, King J, Kipperman R, Kizilbash A, Klancke K, Klein M, Kmonicek J, Kosolcharoen P, Kowalski B, Kraemer M, Kreisman K, Kwan M, Lafoe W, Lai P, Lakow M, Lamas G, Lancaster L, Langager J, Larsen G, Lash J, Lauer M, Laufer N, Laughrun D, Lee C, Leesar M, Lefkovic L, Leimbach W, Leimgruber P, Lenz F, Lessmeier T, Lester M, Levitte M, Lieberman C, Lillestol M, Little L, Lopez F, Lopez M, Losordo D, Lucke J, MacDonald G, Madyoon H, Magorien R, Maher P, Maislos F, Manda R, Mansuri M, McClure R, McCord D, McGreevey MJ, McGrew F, McKoy RC, McLaughlin P, Mehta S, Menapace F, Meyer T, Millar R, Miller G, Miller L, Minisi A, Mitchell J, Mody FV, Mohan KK, Mohiuddin S, Moore C, Moore R, Morris K, Motta M, Muhlestein JB, Murali S, Musser WE, Navas J, Niederman A, Nukta ED, Nygaard T, O'Bryan J, O'Connor C, O'Dea D, Oliveros R, Oparil S, Orchard R, Ostrzega E, Owens J, Pak P, Palac R, Papasifakis E, Paraboschi C, Pearce D, Peizner D, Ponce G, Popper P, Porter C, Prisant LM, Pritza D, Ptacin M, Raab C, Radtke W, Rahko P, Ramirez J, Rana M, Reeves B Jr, Reimers C, Retter K, Revtyak G, Rezkalla S, Rink L, Rivera E, Roark S, Rohrbeck S, Rosenthal J, Rossi P, Sacco J, Saeian K, Saltiel F, Samaha F, Schechter C, Schneider R, Schrank J, Schulman S, Schuyler G, Sequeira R, Shalev Y, Sheikh K, Sheikh S, Siddique M, Siegel R, Silver T, Simek C, Sklar J, Small D, Smith T, Soucier R, Spaedy T, Spatz A, Srivastava N, Stahl A, Stark K, Stein P, Stern M, Stevens T, Stine R, Sundram S, Sutliff G, Taikowski R, Taylor A, Thadani U, Thompson C, Thompson M, Timmis G, Tischler M, Torelli J, Traub S, Treasure C, Tsai C, Tschida V, Tung C, Unks DM, Urban P, Uretsky B, Vaganos N, Vasudemurthy K, Vaughn M, Vasquez-Bauza J, Vijay N, Von Der Lohe E, Vorcheimer D, Voyce S, Wall T, Walsh M, Watkins J, Weiss R, Wenger N, Werner J, Whayne T, Whitsitt T, Wilensky M, Wilmer C, Wilson V, Wolbrette D, Wolinsky D, Wright R, Yaacoub A, Yakubov S, Zakhary B, Zaroff J, Zelenkofske S, Zolnick M, Zwicke D, Boyd C, Adam M, Whittom L, Marquis J, Pascual A, Medina A, Astley C, Schofield M, Kelkar M, Bucan O, Scott M, Lindbratt S, Sherliltz C, Cornwell K, Carlsen J, Mercier R, Spencker T, Pohlner K, Black A, Steven T, Leblanc C, Sellers MA, Rittenhouse L, Sunas L, Leimberger J, Walden A, Moreira M, Houbracken K, Vandenberghe K, Ageev F, Skvortsov A, Narusov O, Mareeva G, Gurskaya J, Shargorodskaya A, Zelenkofske S, Henis M, Edwards S, Han X, Shinomoto J, Barbiero P, Jezek T, Kaczor J, Keating NB, Koempf R, McGarry R, Rossy G, Salemi C, Trapani A.

Author information

  • 1Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA. mpfeffer@rics.bwh.harvard.edu

Erratum in

  • N Engl J Med. 2004 Jan 8;350(2):203.

Abstract

BACKGROUND:

Angiotensin-converting-enzyme (ACE) inhibitors such as captopril reduce mortality and cardiovascular morbidity among patients with myocardial infarction complicated by left ventricular systolic dysfunction, heart failure, or both. In a double-blind trial, we compared the effect of the angiotensin-receptor blocker valsartan, the ACE inhibitor captopril, and the combination of the two on mortality in this population of patients.

METHODS:

Patients receiving conventional therapy were randomly assigned, 0.5 to 10 days after acute myocardial infarction, to additional therapy with valsartan (4909 patients), valsartan plus captopril (4885 patients), or captopril (4909 patients). The primary end point was death from any cause.

RESULTS:

During a median follow-up of 24.7 months, 979 patients in the valsartan group died, as did 941 patients in the valsartan-and-captopril group and 958 patients in the captopril group (hazard ratio in the valsartan group as compared with the captopril group, 1.00; 97.5 percent confidence interval, 0.90 to 1.11; P=0.98; hazard ratio in the valsartan-and-captopril group as compared with the captopril group, 0.98; 97.5 percent confidence interval, 0.89 to 1.09; P=0.73). The upper limit of the one-sided 97.5 percent confidence interval for the comparison of the valsartan group with the captopril group was within the prespecified margin for noninferiority with regard to mortality (P=0.004) and with regard to the composite end point of fatal and nonfatal cardiovascular events (P<0.001). The valsartan-and-captopril group had the most drug-related adverse events. With monotherapy, hypotension and renal dysfunction were more common in the valsartan group, and cough, rash, and taste disturbance were more common in the captopril group.

CONCLUSIONS:

Valsartan is as effective as captopril in patients who are at high risk for cardiovascular events after myocardial infarction. Combining valsartan with captopril increased the rate of adverse events without improving survival.

Copyright 2003 Massachusetts Medical Society

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