They should not be instituted in the immediate postoperative period if the systolic arterial pres- sure is 100 mm Hg or if the patient develops hypotension in the hospital after receiving them. The IMAGINE (Ischemia Management With Accupril Post Bypass Graft via Inhibition of Angiotensin Converting Enzyme) study failed to show a bene- ficial effect of postoperative ACE inhibitor therapy 3 years after CABG, instead noting an increase in adverse events, particularly recurrent angina in the first 3 months of therapy.630 A subanal- ysis of the data from patients enrolled in EUROPA (European Trial on the Reduction of Cardiac Events with Perindopril in Stable Coronary Artery Disease) with previous revascularization (CABG or PCI no sooner than 6 months before enrollment) suggested a primary and secondary prevention benefit over a 4.2-year follow-up period; however, an analysis of the data from almost 3000 patients in the PREVENT IV (PRoject of Ex-vivo Vein graft ENgineering via Transfection) trial, all of whom were taking either ACE inhibitors or ARBs at the time of hospital discharge, failed to demonstrate a significant reduction in death or MI after 2 years of follow-up in ideal candidates (based on P NS), whereas significance was achieved in non-ideal candi- 4.7. Smoking Cessation: Recommendations Class I 1. All smokers should receive in-hospital educational counseling and be offered smoking cessation therapy during CABG hospitalization.642 644 (Level of Evi- dence: A) Class IIb 1. The effectiveness of pharmacological therapy for smoking cessation offered to patients before hospital discharge is uncertain. (Level of Evidence: C) See Online Data Supplement 28 for additional data on smoking cessation. Smoking cessation after CABG is associated with a sub- stantial reduction in subsequent MACE, including MI and death. 