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Imagine Trial

Article

Initiating therapy with the ACE inhibitor quinapril within the first 7 days after coronary artery bypass graft (CABG) surgery does not lead to better outcomes among patients already receiving optimal therapy, said Wiek H. van Gilst, MD, lead investigator of IMAGINE (Ischemia Management with Accupril Post Bypass Graft via Inhibition of Angiotensin Converting Enzyme).

Initiating therapy with the ACE inhibitor quinapril within the first 7 days after coronary artery bypass graft (CABG) surgery does not lead to better outcomes among patients already receiving optimal therapy, said Wiek H. van Gilst, MD, lead investigator of IMAGINE (Ischemia Management with Accupril Post Bypass Graft via Inhibition of Angiotensin Converting Enzyme). The results from IMAGINE were presented at the European Society of Cardiology Congress 2005 in Stockholm, Sweden.

"The results suggest that current optimal treatment is not improved by the addition of an ACE inhibitor for patients who do not have a previous clinical need for the drug," said Dr van Gilst, professor of cardiovascular and clinical pharmacology, University Medical Center Groningen, The Netherlands. Background therapy included a high rate of statins, beta blockers, and aspirin, he noted.

In IMAGINE, 2,553 patients who had undergone CABG in the previous 7 days were randomized to quinapril 40 mg/d or placebo. The premise was that the endothelial dysfunction and inflammation that is common after CABG would be treated effectively with ACE inhibition. Other than the need for CABG, the population was relatively low-risk, with only 39% having a history of MI and only 10% having diabetes.

The results "warrant caution when starting an ACE inhibitor in the early phase post-CABG in a low-risk population treated with contemporary therapy," said Dr van Gilst.

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