Abstract 3171: Racial Analysis of Patients with Myocardial Infarction Complicated by Heart Failure and/or Left Ventricular Dysfunction Treated with Valsartan, Captopril, or Both
Introduction. African Americans have the highest incidence of heart failure (HF) in the United States. Limited retrospective observational analyses of patients with left ventricular systolic dysfunction (LVSD) suggest marginal benefit of ACE inhibitors on the prevention of HF hospitalizations or total mortality in African Americans, and very little data exist concerning the effectiveness of angiotensin receptor blockers in this population.
Methods. Patients with an acute myocardial infarction (MI) and HF and/or LVSD enrolled within the US (3390 white, 340 African American) in the VALIANT trial, were compared to assess differences in baseline characteristics, treatments, and outcomes. Patients were randomized to treatment with valsartan, captopril, or the combination, and follow-up continued for up to 3 years.
Results. African Americans had more coronary risk factors, more markers of poor outcome after acute MI, and were less likely to undergo coronary revascularization when compared with whites. 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 American patients with HF and/or LVSD following an acute MI had similar clinical outcomes to white patients in the U.S. after adjusting for differences in baseline risk and concurrent treatment. The use of valsartan, captopril, or the combination post acute MI had similar effects on cardiovascular morbidity and mortality among African Americans and whites.