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Previous Volume 352:1646-1654 April 21, 2005 Number 16 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Anderson, J. L. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Chlamydia pneumoniae has been found within atherosclerotic plaques, and elevated titers of antibody to this organism have been linked to a higher risk of coronary events. Pilot studies have suggested that antibiotic treatment may reduce the risk of cardiovascular events.

Methods We enrolled 4162 patients who had been hospitalized for an acute coronary syndrome within the preceding 10 days and evaluated the efficacy of long-term treatment with gatifloxacin, a bactericidal antibiotic known to be effective against C. pneumoniae, in a double-blind, randomized, placebo-controlled trial. Subjects received 400 mg of gatifloxacin daily during an initial 2-week course of therapy that began 2 weeks after randomization, followed by a 10-day course every month for the duration of the trial (mean duration, 2 years), or placebo. The primary end point was a composite of death from all causes, myocardial infarction, documented unstable angina requiring rehospitalization, revascularization (performed at least 30 days after randomization), and stroke.

Results A Kaplan–Meier analysis revealed that the rates of primary-end-point events at two years were 23.7 percent in the gatifloxacin group and 25.1 percent in the placebo group (hazard ratio, 0.95; 95 percent confidence interval, 0.84 to 1.08; P=0.41). No benefit was seen in any of the prespecified secondary end points or in any of the prespecified subgroups, including patients with elevated titers to C. pneumoniae or C-reactive protein.

Conclusions Despite long-term treatment with a bactericidal antibiotic effective against C. pneumoniae, no reduction in the rate of cardiovascular events was observed.

Source Information

From the Thrombolysis in Myocardial Infarction Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston (C.P.C., E.B., C.H.M., R.P.G.); the Department of Epidemiology, University of Washington, Seattle (J.T.G.); LDS Hospital, Salt Lake City (B.M.); and Nottingham Clinical Research Group, Nottingham, United Kingdom (R.C., A.M.S.).

Address reprint requests to Dr. Cannon at the TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, or at cpcannon{at}partners.org.

Full Text of this Article

Related Letters:

Chlamydia pneumoniae and Acute Coronary Syndrome
Wong B. Y.L., Gnarpe J., Mitchell W. M., Stratton C. W., Frothingham R., Paul M., Fraser A., Leibovici L., Grayston J. T., Cannon C. P., the ACES Investigators , the PROVE IT–TIMI 22 Investigators
Extract | Full Text | PDF  
N Engl J Med 2005; 353:525-528, Aug 4, 2005. Correspondence

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