{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T15:44:58Z","timestamp":1791474298485,"version":"4.3.4"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2008,1]]},"abstract":"<jats:p>\n                    <jats:bold>\n                      <jats:italic>Background\u2014<\/jats:italic>\n                    <\/jats:bold>\n                    Early after coronary artery bypass surgery (CABG), activation of numerous neurohumoral and endogenous vasodilator systems occurs that could be influenced favorably by angiotensin-converting enzyme inhibitors.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>\n                      <jats:italic>Methods and Results\u2014<\/jats:italic>\n                    <\/jats:bold>\n                    The Ischemia Management with Accupril post\u2013bypass Graft via Inhibition of the coNverting Enzyme (IMAGINE) trial tested whether early initiation (\u22647 days) of an angiotensin-converting enzyme inhibitor after CABG reduced cardiovascular events in stable patients with left ventricular ejection fraction \u226540%. The trial was a double-blind, placebo-controlled study of 2553 patients randomly assigned to quinapril, target dose 40 mg\/d, or placebo, who were followed up to a maximum of 43 months. The mean (SD) age was 61 (10) years. The incidence of the primary composite end point (cardiovascular death, resuscitated cardiac arrest, nonfatal myocardial infarction, coronary revascularization, unstable angina or heart failure requiring hospitalization, documented angina, and stroke) was 13.7% in the quinapril group and 12.2% in the placebo group (hazard ratio 1.15, 95% confidence interval 0.92 to 1.42,\n                    <jats:italic>P<\/jats:italic>\n                    =0.212) over a median follow-up of 2.95 years. The incidence of the primary composite end point increased significantly in the first 3 months after CABG in the quinapril group (hazard ratio 1.52, 95% confidence interval 1.03 to 2.26,\n                    <jats:italic>P<\/jats:italic>\n                    =0.0356). Adverse events also increased in the quinapril group, particularly during the first 3 months after CABG.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>\n                      <jats:italic>Conclusions\u2014<\/jats:italic>\n                    <\/jats:bold>\n                    In patients at low risk of cardiovascular events after CABG, routine early initiation of angiotensin-converting enzyme inhibitor therapy does not appear to improve clinical outcome up to 3 years after CABG; however, it increases the incidence of adverse events, particularly early after CABG. Thus, early after CABG, initiation of angiotensin-converting enzyme inhibitor therapy should be individualized and continually reassessed over time according to risk.\n                  <\/jats:p>","DOI":"10.1161\/circulationaha.106.685073","type":"journal-article","created":{"date-parts":[[2007,12,10]],"date-time":"2007-12-10T20:46:43Z","timestamp":1197319603000},"page":"24-31","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":128,"title":["Effects of Angiotensin-Converting Enzyme Inhibition in Low-Risk Patients Early After Coronary Artery Bypass Surgery"],"prefix":"10.1161","volume":"117","author":[{"given":"Jean L.","family":"Rouleau","sequence":"first","affiliation":[{"name":"From the Research Center, Montreal Heart Institute and University of Montreal (J.L.R.), Montreal, Quebec, Canada; Department of Cardiology, Foothills Hospital, University of Calgary (W.J.W.), Calgary, Alberta, Canada; Department of Cardiology, Ho\u0302pital Laval, Laval University (R.B.), Quebec City, Quebec, Canada; Department of Cardiology, Academisch Ziekenhuis Vrije Universiteit (P.J.B.), Brussels, Belgium; Department of Cardiology, Universite\u0301 of Franche-Comte\u0301 (S.C.), Besanc\u0327on, France; Walter C...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wayne J.","family":"Warnica","sequence":"additional","affiliation":[{"name":"From the Research Center, Montreal Heart Institute and University of Montreal (J.L.R.), Montreal, Quebec, Canada; Department of Cardiology, Foothills Hospital, University of Calgary (W.J.W.), Calgary, Alberta, Canada; Department of Cardiology, Ho\u0302pital Laval, Laval University (R.B.), Quebec City, Quebec, Canada; Department of Cardiology, Academisch Ziekenhuis Vrije Universiteit (P.J.B.), Brussels, Belgium; Department of Cardiology, Universite\u0301 of Franche-Comte\u0301 (S.C.), Besanc\u0327on, France; Walter C...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Baillot","sequence":"additional","affiliation":[{"name":"From the Research Center, Montreal Heart Institute and University of Montreal (J.L.R.), Montreal, Quebec, Canada; Department of Cardiology, Foothills Hospital, University of Calgary (W.J.W.), Calgary, Alberta, Canada; Department of Cardiology, Ho\u0302pital Laval, Laval University (R.B.), Quebec City, Quebec, Canada; Department of Cardiology, Academisch Ziekenhuis Vrije Universiteit (P.J.B.), Brussels, Belgium; Department of Cardiology, Universite\u0301 of Franche-Comte\u0301 (S.C.), Besanc\u0327on, France; Walter C...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre J.","family":"Block","sequence":"additional","affiliation":[{"name":"From the Research Center, Montreal Heart Institute and University of Montreal (J.L.R.), Montreal, Quebec, Canada; Department of Cardiology, Foothills Hospital, University of Calgary (W.J.W.), Calgary, Alberta, Canada; Department of Cardiology, Ho\u0302pital Laval, Laval University (R.B.), Quebec City, Quebec, Canada; Department of Cardiology, Academisch Ziekenhuis Vrije Universiteit (P.J.B.), Brussels, Belgium; Department of Cardiology, Universite\u0301 of Franche-Comte\u0301 (S.C.), Besanc\u0327on, France; Walter C...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sidney","family":"Chocron","sequence":"additional","affiliation":[{"name":"From the Research Center, Montreal Heart Institute and University of Montreal (J.L.R.), Montreal, Quebec, Canada; Department of Cardiology, Foothills Hospital, University of Calgary (W.J.W.), Calgary, Alberta, Canada; Department of Cardiology, Ho\u0302pital Laval, Laval University (R.B.), Quebec City, Quebec, Canada; Department of Cardiology, Academisch Ziekenhuis Vrije Universiteit (P.J.B.), Brussels, Belgium; Department of Cardiology, Universite\u0301 of Franche-Comte\u0301 (S.C.), Besanc\u0327on, France; Walter C...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Johnstone","sequence":"additional","affiliation":[{"name":"From the Research Center, Montreal Heart Institute and University of Montreal (J.L.R.), Montreal, Quebec, Canada; Department of Cardiology, Foothills Hospital, University of Calgary (W.J.W.), Calgary, Alberta, Canada; Department of Cardiology, Ho\u0302pital Laval, Laval University (R.B.), Quebec City, Quebec, Canada; Department of Cardiology, Academisch Ziekenhuis Vrije Universiteit (P.J.B.), Brussels, Belgium; Department of Cardiology, Universite\u0301 of Franche-Comte\u0301 (S.C.), Besanc\u0327on, France; Walter C...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin G.","family":"Myers","sequence":"additional","affiliation":[{"name":"From the Research Center, Montreal Heart Institute and University of Montreal (J.L.R.), Montreal, Quebec, Canada; Department of Cardiology, Foothills Hospital, University of Calgary (W.J.W.), Calgary, Alberta, Canada; Department of Cardiology, Ho\u0302pital Laval, Laval University (R.B.), Quebec City, Quebec, Canada; Department of Cardiology, Academisch Ziekenhuis Vrije Universiteit (P.J.B.), Brussels, Belgium; Department of Cardiology, Universite\u0301 of Franche-Comte\u0301 (S.C.), Besanc\u0327on, France; Walter C...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina-Dana","family":"Calciu","sequence":"additional","affiliation":[{"name":"From the Research Center, Montreal Heart Institute and University of Montreal (J.L.R.), Montreal, Quebec, Canada; Department of Cardiology, Foothills Hospital, University of Calgary (W.J.W.), Calgary, Alberta, Canada; Department of Cardiology, Ho\u0302pital Laval, Laval University (R.B.), Quebec City, Quebec, Canada; Department of Cardiology, Academisch Ziekenhuis Vrije Universiteit (P.J.B.), Brussels, Belgium; Department of Cardiology, Universite\u0301 of Franche-Comte\u0301 (S.C.), Besanc\u0327on, France; Walter C...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Dalle-Ave","sequence":"additional","affiliation":[{"name":"From the Research Center, Montreal Heart Institute and University of Montreal (J.L.R.), Montreal, Quebec, Canada; Department of Cardiology, Foothills Hospital, University of Calgary (W.J.W.), Calgary, Alberta, Canada; Department of Cardiology, Ho\u0302pital Laval, Laval University (R.B.), Quebec City, Quebec, Canada; Department of Cardiology, Academisch Ziekenhuis Vrije Universiteit (P.J.B.), Brussels, Belgium; Department of Cardiology, Universite\u0301 of Franche-Comte\u0301 (S.C.), Besanc\u0327on, France; Walter C...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre","family":"Martineau","sequence":"additional","affiliation":[{"name":"From the Research Center, Montreal Heart Institute and University of Montreal (J.L.R.), Montreal, Quebec, Canada; Department of Cardiology, Foothills Hospital, University of Calgary (W.J.W.), Calgary, Alberta, Canada; Department of Cardiology, Ho\u0302pital Laval, Laval University (R.B.), Quebec City, Quebec, Canada; Department of Cardiology, Academisch Ziekenhuis Vrije Universiteit (P.J.B.), Brussels, Belgium; Department of Cardiology, Universite\u0301 of Franche-Comte\u0301 (S.C.), Besanc\u0327on, France; Walter C...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Mormont","sequence":"additional","affiliation":[{"name":"From the Research Center, Montreal Heart Institute and University of Montreal (J.L.R.), Montreal, Quebec, Canada; Department of Cardiology, Foothills Hospital, University of Calgary (W.J.W.), Calgary, Alberta, Canada; Department of Cardiology, Ho\u0302pital Laval, Laval University (R.B.), Quebec City, Quebec, Canada; Department of Cardiology, Academisch Ziekenhuis Vrije Universiteit (P.J.B.), Brussels, Belgium; Department of Cardiology, Universite\u0301 of Franche-Comte\u0301 (S.C.), Besanc\u0327on, France; Walter C...."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wiek H.","family":"van Gilst","sequence":"additional","affiliation":[{"name":"From the Research Center, Montreal Heart Institute and University of Montreal (J.L.R.), Montreal, Quebec, Canada; Department of Cardiology, Foothills Hospital, University of Calgary (W.J.W.), Calgary, Alberta, Canada; Department of Cardiology, Ho\u0302pital Laval, Laval University (R.B.), Quebec City, Quebec, Canada; Department of Cardiology, Academisch Ziekenhuis Vrije Universiteit (P.J.B.), Brussels, Belgium; Department of Cardiology, Universite\u0301 of Franche-Comte\u0301 (S.C.), Besanc\u0327on, France; Walter C...."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(00)02212-1"},{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200001203420301"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)14286-9"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa042739"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/0033-0620(91)90019-I"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.97.1.16"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(91)90835-W"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/heart.83.1.69"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1161\/circ.94.3.258"},{"key":"e_1_3_2_10_2","first-page":"541","volume":"87","year":"2001","unstructured":"Oosterga M, Voors AA, Pinto YM, Buikema H, Grandjean JG, Kingma JH, Crijns HJ, van Gilst WH. 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