Background-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. Methods and Results-The Ischemia Management with Accupril post-bypass Graft via Inhibition of the coNvertingEnzyme (IMAGINE) trial tested whether early initiation (Յ7 days) of an angiotensin-converting enzyme inhibitor after CABG reduced cardiovascular events in stable patients with left ventricular ejection fraction Ն40%. 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, Pϭ0.212) 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, Pϭ0.0356). Adverse events also increased in the quinapril group, particularly during the first 3 months after CABG. Conclusions-In patients at low risk of cardiovascular events after CABG, routine early initiation of angiotensinconverting 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. (Circulation. 2008;117:24-31.)

The activity records of five groups of healthy or ill subjects have been measured for 4-26 days by an accelerometer placed on the nondominant wrist. These data, together with a record of times retiring to/rising from bed, have been used to produce a series of dichotomy indices for comparing the amounts of activity when in bed and out of bed. Reliable differences between individuals were found, with healthy subjects showing a greater degree of dichotomy than one subject with delayed sleep phase syndrome or three subjects with colorectal cancer. The method is convenient for extended data collection and offers the possibility of describing an individual's activity profile in a variety of circumstances.