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(Circulation. 2005;112:3365.)
© 2005 American Heart Association, Inc.

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An extract of the first 250 words of the full text is provided, because this article has no abstract.

	MORTALITY AND MORBIDITY REMAIN HIGH DESPITE CAPTOPRIL AND/OR VALSARTAN THERAPY IN ELDERLY PATIENTS WITH LEFT VENTRICULAR SYSTOLIC DYSFUNCTION, HEART FAILURE, OR BOTH AFTER ACUTE MYOCARDIAL INFARCTION: RESULTS FROM THE VALSARTAN IN ACUTE MYOCARDIAL INFARCTION TRIAL (VALIANT), by White et al.

 
The elderly make up an increasing proportion of patients having an acute myocardial infarction and account for most of the morbidity and mortality. They often are underrepresented in clinical trials. The VALIANT trial had no age exclusions, and more than 3000 patients 75 years of age or older with heart failure and/or a depressed ejection fraction were randomized 5 days after acute myocardial infarction. There was no difference in outcomes among the study treatments (captopril, valsartan, or combination). Adverse events were more common in older patients. Each 10-year increase in age was associated with an almost 50% increase in mortality and a 38% increase in the likelihood of having a readmission for heart failure. Although at higher risk, the elderly less frequently received evidence-based therapy (aspirin, ß-blockers, and statins). The authors recommended greater use of evidence-based therapies and suggested that new therapies are required to improve outcomes in this important group of patients. See p 3391.

	OUTCOMES AND ASSOCIATED RISK FACTORS FOR AORTIC VALVE REPLACEMENT IN 160 CHILDREN: A COMPETING-RISKS ANALYSIS, by Karamlou et al.

 
Aortic valve replacement (AVR) in children poses unique challenges that have hampered identification of the ideal prosthesis. Karamlou and colleagues report a single-center experience with 160 children undergoing AVR. Ten years after initial AVR, 19% had died without subsequent AVR; 34% underwent a second AVR; and 47% remained alive without replacement. Younger age, lower operative weight, concomitant performance of aortic root replacement or reconstruction, and use of a prosthesis type other than a pulmonary autograft were significant predictors of death without a repeat AVR. Risk factors for earlier repeat AVR included the use . . . [Full Text of this Article]

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