Ischemia Management with Accupril Post Bypass Graft via Inhibition of Angiotensin Converting Enzyme IMAGINEIMAGINE Presented at The European Society of Cardiology Hot Line Session, September 2005 Presented by Dr. W H van Gilst

www. Clinical trial results.org Quinapril (up to 40mg/day) n = 1280 Quinapril (up to 40mg/day) n = 1280 Endpoints:  Primary – composite of cardiovascular death or resuscitated cardiac arrest, non fatal MI, coronary revascularization, hospitalization for unstable angina, documented angina not requiring hospitalization, stroke, or heart failure requiring hospitalization Endpoints:  Primary – composite of cardiovascular death or resuscitated cardiac arrest, non fatal MI, coronary revascularization, hospitalization for unstable angina, documented angina not requiring hospitalization, stroke, or heart failure requiring hospitalization IMAGINE ESC 2005 Placebo n = 1273 Placebo n = patients within 7 days post-CABG, stable post-operatively, in hospital at the time of randomization, LV ejection fraction >40%

www. Clinical trial results.org IMAGINE: Primary endpoint The primary composite endpoint of cardiovascular death or resuscitated cardiac arrest, non fatal MI, coronary revascularization, hospitalization for unstable angina, documented angina not requiring hospitalization, stroke, or heart failure requiring hospitalization was not significantly different in the quinapril group compared to placebo (Hazard ratio: 1.15, 95% Cl , p = 0.224) The primary composite endpoint of cardiovascular death or resuscitated cardiac arrest, non fatal MI, coronary revascularization, hospitalization for unstable angina, documented angina not requiring hospitalization, stroke, or heart failure requiring hospitalization was not significantly different in the quinapril group compared to placebo (Hazard ratio: 1.15, 95% Cl , p = 0.224) The endpoint was numerically but not significantly higher in the quinapril group The endpoint was numerically but not significantly higher in the quinapril group ESC 2005

www. Clinical trial results.org IMAGINE: Components of Primary Endpoint ESC 2005

www. Clinical trial results.org IMAGINE: Summary Among patients undergoing coronary artery bypass surgery, initiation of the ACE- inhibitor quinapril early post surgery was not associated with a difference in the primary composite endpoint compared with placebo at a median three year follow-up, with data suggesting a possible increased risk during the first three months following surgery. Data from large trials such as EUROPA and HOPE support the use of ACE-inhibitor therapy in stable coronary artery disease patients. Patients in the present study, while post-bypass surgery, were relatively low-risk (mean ejection fraction 60%) and had to be stable post-operatively to be enrolled. Despite these characteristics, early initiation of quinapril within 7 days of surgery was associated with no late benefit. Among patients undergoing coronary artery bypass surgery, initiation of the ACE- inhibitor quinapril early post surgery was not associated with a difference in the primary composite endpoint compared with placebo at a median three year follow-up, with data suggesting a possible increased risk during the first three months following surgery. Data from large trials such as EUROPA and HOPE support the use of ACE-inhibitor therapy in stable coronary artery disease patients. Patients in the present study, while post-bypass surgery, were relatively low-risk (mean ejection fraction 60%) and had to be stable post-operatively to be enrolled. Despite these characteristics, early initiation of quinapril within 7 days of surgery was associated with no late benefit. ESC 2005