Scirica, B. M., Morrow, D. A., Bode, C., Ruzyllo, W., Ruda, M., Oude Ophuis, A. J., Lopez-Sendon, J., Swedberg, K., Ogorek, M., Rifai, N., Lukashevich, V., Maboudian, M., Cannon, C. P., McCabe, C. H., Braunwald, E. Patients with acute coronary syndromes and elevated levels of natriuretic peptides: the results of the AVANT GARDE-TIMI 43 Trial European heart journal. 2010;31(16):1993-2005.

AIMS: Elevated natriuretic peptides (NPs) are associated with an increased cardiovascular risk following acute coronary syndromes (ACSs). However, the therapeutic implications are still undefined. We hypothesized that early inhibition of renin-angiotensin-aldosterone system (RAAS) in patients with preserved left ventricular function but elevated NPs but following ACS would reduce haemodynamic stress as reflected by a greater reduction NP compared with placebo.

METHODS AND RESULTS: AVANT GARDE-TIMI 43 trial, a multinational, double-blind trial, randomized 1101 patients stabilized after ACS without clinical evidence of heart failure or left ventricular function
CONCLUSION: In this study of a high-risk population with elevated levels of NPs but relatively preserved systolic function and no evidence of heart failure following ACS, there was no evidence for a benefit of early initiation of inhibition of RAAS with valsartan, aliskiren, or their combination compared with placebo with respect to a reduction in NP over 8 weeks of therapy. Moreover, adverse events were reported more frequently in patients assigned to active therapy.