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The VALIANT Registry

Adrian F. Hernandez, MD; Eric J. Velazquez, MD; Scott D. Solomon, MD; Rakhi Kilaru, MS; Rafael Diaz, MD; Christopher M. O’Connor, MD; George Ertl, MD; Aldo P. Maggioni, MD; Jean-Lucien Rouleau, MD; Wiek van Gilst, PhD; Marc A. Pfeffer, MD, PhD; Robert M. Califf, MD

Arch Intern Med. 2005;165:2162-2169.

Background  How often echocardiography and cardiac catheterization are used to evaluate left ventricular (LV) function in patients with myocardial infarction (MI) and how they are associated with quality of care is unknown.

Methods  Patients with MI in the Valsartan in Acute Myocardial Infarction (VALIANT) registry were divided into those with (n = 1423) and without (n = 3968) heart failure (HF), and the use of either echocardiography or cardiac catheterization for LV assessment in each group was compared along with associated baseline characteristics. We evaluated the association between LV assessment and discharge medications. Using a multivariable model with a propensity analysis, we evaluated the association of LV assessment with in-hospital outcomes.

Results  Of the patients with HF, 322 (22.6%) had no LV assessment. Patients with HF with LV assessment were discharged more frequently under treatment with aspirin (81.3% vs 70.0%; P<.001), -blockers (65.6% vs 56.4%; P = .008), clopidogrel (30.4% vs 14.0%; P<.001), and statins (45.9% vs 34.2%; P<.001). Patients without HF who underwent LV assessment were discharged more frequently under treatment with an angiotensin-converting enzyme inhibitor (53.8% vs 41.5%; P<.001). After adjustment for regional use, other covariates, and revascularization, LV assessment was associated with lower in-hospital mortality in patients with HF (adjusted odds ratio [OR], 0.45; P<.001) and in patients without HF (adjusted OR, 0.30; P<.001). After excluding deaths during the first 2 days, LV assessment remained associated with lower mortality in patients with HF (adjusted OR, 0.59; P = .03) and in patients without HF (adjusted OR, 0.41; P<.001).

Conclusion  Left ventricular assessment was frequently not performed during the in-hospital stay of patients with acute MI, including those with clinical HF, and its use was associated with better quality of care.

Author Affiliations: Division of Cardiology, Department of Medicine, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC (Drs Hernandez, Velazquez, O’Connor, and Califf and Ms Kilaru); Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass (Drs Solomon and Pfeffer); Instituto Cardiovascular de Rosario, Rosario, Argentina (Dr Diaz); Medizinische Universitätsklinik, Würzburg, Germany (Dr Ertl); ANMCO Research Center, Florence, Italy (Dr Maggioni); Montreal Heart Institute, Montreal, Quebec (Dr Rouleau); and Rijksuniversiteit Groningen, Groningen, the Netherlands (Dr van Gilst).

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