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CLINICAL RESEARCH: MYOCARDIAL INFARCTION

Racial Analysis of Patients With Myocardial Infarction Complicated by Heart Failure and/or Left Ventricular Dysfunction Treated With Valsartan, Captopril, or Both

L. Michael Prisant, MD, FACC^_*,_*, Kevin L. Thomas, MD, Eldrin F. Lewis, MD, MPH, Zhen Huang, MS, Gary S. Francis, MD, FACC, W. Douglas Weaver, MD, FACC^||, Marc A. Pfeffer, MD, PhD, FACC, John J.V. McMurray, MD, FACC^¶, Robert M. Califf, MD, MACC and Eric J. Velazquez, MD, FACC

^_* Hypertension and Clinical Pharmacology, Medical College of Georgia, Augusta, Georgia
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
Brigham and Women's Hospital, Boston, Massachusetts
The Cleveland Clinic Foundation, Cleveland, Ohio
^|| Henry Ford Heart and Vascular Institute, Detroit, Michigan
^¶ Western Infirmary, Glasgow, Scotland.

Manuscript received December 1, 2006; revised manuscript received December 7, 2007, accepted December 11, 2007.

^_* Reprint requests and correspondence: Dr. L. Michael Prisant, HB-2010, 1467 Harper Street, Medical College of Georgia, Augusta, Georgia 30912. (Email: mprisant{at}mail.mcg.edu).

Objectives: African Americans have a high incidence of heart failure (HF). Limited retrospective observational subgroup analyses of patients with left ventricular systolic dysfunction (LVSD) suggest marginal benefit of angiotensin-converting enzyme inhibitors in the prevention of HF hospitalizations or total mortality in African Americans.

Background: Very few data exist concerning the effectiveness of angiotensin receptor blockers in this population.

Methods: Baseline characteristics, treatments, and outcomes of patients from the U.S. (3,390 white and 340 African-American patients) in the VALIANT (VALsartan In Acute myocardial iNfarcTion) trial were compared. This trial included patients with an acute myocardial infarction (MI) after initial stabilization and documented LVSD and/or HF. Patients were randomly assigned to receive treatment with valsartan, captopril, or the combination; follow-up continued for up to 3 years (median 24.7 months).

Results: African Americans had more coronary risk factors, more markers of poor outcome after MI, and were less likely to be revascularized when compared with white patients. After adjusting for treatment assignment, baseline characteristics, and post-infarction parameters, no difference was found in the 3-year rate of all-cause mortality, cardiovascular mortality, rehospitalization for HF, recurrent MI, or stroke between the 2 groups.

Conclusions: African Americans sustaining an acute MI with LVSD and/or HF had similar clinical outcomes compared with white Americans. Valsartan, captopril, or the combination had comparable effects on cardiovascular morbidity and mortality in African Americans and white Americans.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   ARB = angiotensin receptor blocker   CABG = coronary artery bypass grafting   CHD = coronary heart disease   eGFR = estimated glomerular filtration rate   HF = heart failure   LVSD = left ventricular systolic dysfunction   MI = myocardial infarction   PCI = percutaneous coronary intervention

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