Effects of quinapril on clinical outcome after coronary artery bypass grafting (The QUO VADIS study)

study was designed to explore whether 1 year of angiotensin-converting enzy me inhibition with quinapril (40 mg/day) would decrease ischemia in patient s who underwent coronary artery bypass grafting (CABG), Patients (n = 149) scheduled for CABG were randomized 4 weeks before surgery. Study medication was used from randomization vp to 1 year after CABG, Exercise testing was performed at randomization; the exercise test was repeated 1 year after CAB G and patients underwent 48-hour Holter monitoring, Clinical ischemic event s were recorded and defined as death, revascularization, myocardial infarct ion, recurrence of angina pectoris, ischemic stroke, or transient ischemic attack, Baseline characteristics were similar between groups. Total exercis e time increased overall by 75 +/- 76 seconds 1 year after CABG (placebo +7 9 +/- 75 seconds, quinapril +72 +/- 79 seconds, p = 0.6), All patients had ischemic ST-segment changes at randomization; 33% of patients had ischemic ST-segment changes 1 year after CABG (placebo 29%, quinapril 37%, p = 0.4), On Holter monitoring, the number of patients experiencing greater than or equal to1 episodes of ischemia was equal in both groups, Treatment with qui napril significantly reduced clinical ischemic events after CABG: 15% in pa tients on placebo versus 4% of patients on quinapril (hazard ratio 0.23, 95 % confidence interval 0.06 to 0,87, p = 0.02), Longterm quinapril treatment significantly reduced clinical ischemic events within 1 year after CABG, a lthough ischemia at exercise testing and Halter monitoring was unchanged. ( C) 2001 by Excerpta Medica, Inc.