The QUinapril Ischemic Event Trial (OUIET): Evaluation of chronic ACE inhibitor therapy in patients with ischemic heart disease and preserved left ventricular function

Angiotensin-converting enzyme inhibitors improve endothelial function, inhi bit experimental atherogenesis, and decrease ischemic events. The Quinapril Ischemic Event Trial was designed to test the hypothesis that quinapril 20 mg/day would reduce ischemic events (the occurrence of cardiac death, resu scitated cardiac arrest, nonfatal myocardial infarction, coronary artery by pass grafting, coronary angioplasty, or hospitalization for angina pectoris ) and the angiographic progression of coronary artery disease in patients w ithout systolic left ventricular dysfunction. A total of 1,750 patients wer e randomized to quinapril 20 mg/day or placebo and followed a mean of 27 +/ - 0.3 months. The 38% incidence of ischemic events was similar for bath gro ups (RR 1.04; 95% confidence interval 0.89 to 1.22: p = 0.6). There was als o no significant difference in the incidence of patients having angiographi c progression of coronary disease (p = 0,71). The rate of development of ne w coronary lesions was also similar in both groups (p = 0.35). However, the re was a difference in the incidence of angioplasty for new (previously uni ntervened) vessels (p = 0.018), Quinapril was well tolerated in patients af ter angioplasty with normal left ventricular function, Quinapril 20 mg did not significantly affect the overall frequency of clinical outcomes or the progression of coronary atherosclerosis. However, the absence of the demons trable effect of quinapril may be due to several limitations in study desig n. (C) 2001 by Excerpta Medica, Inc.