Evidence map›Paper›PMID 14610160›Full record

Trial reportThe New England journal of medicine2003

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

Marc A Pfeffer, John J V McMurray, Eric J Velazquez, Jean-Lucien Rouleau, Lars Køber, Aldo P Maggioni, Scott D Solomon, Karl Swedberg, Frans Van de Werf, Harvey White and 7 more

Erratum issued Registry-linked trialOpen access · bronzeAbstract readClinical TrialMulticenter StudyRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in The New England journal of medicine, 2003. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. It is linked to trial NCT00725738 (Intracoronary Autologous Stem Cell Transplantation in ST Elevation Myocardial Infarction), which is not on this map. Cited by 572 papers, 24 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
572citing papers in PubMed, 24 pooled it
107.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT00725738 phase2 / phase3unknown statusnot on this mapstarted 2008, after this paper: background citation

Intracoronary Autologous Stem Cell Transplantation in ST Elevation Myocardial Infarction: TRACIA Study.

TypeinterventionalSponsorNational Heart Institute, MexicoRan2008 to 2009Enrolled80ConditionsAcute Myocardial InfarctionArmsStem Cell Transplantation
3 · Its place in the literature

Who cites it

572 citing papers in PubMed, 24 syntheses or guidelines pooled it, 2,479 citations in OpenAlex.

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  2. The Japanese Society of Hypertension Guidelines for the management of elevated blood pressure and hypertension 2025 (JSH2025).Hypertension research : official journal of the Japanese Society of Hypertension · 2026
    Guideline
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512 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

17 authors at 7 institutions in 6 countries.

Marc A PfefferCardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115, USA. mpfeffer@rics.bwh.harvard.edu
John J V McMurray
Eric J Velazquez
Jean-Lucien Rouleau
Lars Køber
Aldo P Maggioni
Scott D Solomon
Karl Swedberg
Frans Van de Werf
Harvey White
Jeffrey D Leimberger
Marc Henis
Susan Edwards
Steven Zelenkofske
Mary Ann Sellers
Robert M Califf
Valsartan in Acute Myocardial Infarction Trial Investigators
Duke Medical Center · USBrigham and Women's Hospital · USAssociazione Nazionale Medici Cardiologi Ospedalieri · ITGreenlane Clinical Centre · NZMontreal Heart Institute · CARigshospitalet · DKSahlgrenska University Hospital · SE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundAngiotensin-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.

methodsPatients 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.

resultsDuring 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.

conclusionsValsartan 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.

Indexed as

Angiotensin Receptor AntagonistsAgedAngiotensin-Converting Enzyme InhibitorsCaptoprilCardiovascular DiseasesDouble-Blind MethodDrug Therapy, CombinationFemaleHeart FailureHumansMaleMiddle AgedMyocardial InfarctionTetrazolesValineValsartanAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsCaptoprilTetrazolesValineValsartan

Identifiers

PMID14610160
OpenAlexW2168907840

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.