Algoritmo

new england journal of medicine
The
established in 1812

november 13 , 2003

vol. 349

no. 20

Valsartan, Captopril, or Both in Myocardial Infarction Complicated by Heart Failure, LeftVentricular Dysfunction, or Both
Marc A. Pfeffer, M.D., Ph.D., John J.V. McMurray, M.D., Eric J. Velazquez, M.D., Jean-Lucien Rouleau, M.D., Lars Køber, M.D., Aldo P. Maggioni, M.D., Scott D. Solomon,M.D., Karl Swedberg, M.D., Ph.D., Frans Van de Werf, M.D., Ph.D., Harvey White, D.Sc., Jeffrey D. Leimberger, Ph.D., Marc Henis, M.D., Susan Edwards, M.S., Steven Zelenkofske, D.O., Mary Ann Sellers,M.S.N., and Robert M. Califf, M.D., for the Valsartan in Acute Myocardial Infarction Trial Investigators*

abstract
background

Angiotensin-converting–enzyme (ACE) inhibitors such as captoprilreduce 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 comparedthe 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 receivingconventional 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 thevalsartan-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; hazardratio in the valsartanand-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...