title: Infectious agents in coronary lesions obtained by endatherectomy: pattern of distribution, coinfection, and clinical findings.
abstract: BACKGROUND
  Cytomegalovirus (CMV), Chlamydia pneumoniae (C. pneumoniae), and Helicobacter pylori (H. pylori) have been implicated in atherosclerosis and restenosis after angioplasty. The patterns of distribution within coronary lesions and possible coinfections of these pathogens in the coronary vasculature had not previously been evaluated.
  
  
  METHODS
  A prospective, observational clinical study.
  
  
  METHODS
  Large coronary specimens (9-105 mm long) were obtained by endatherectomy of 53 patients undergoing aortocoronary bypass surgery. Samples were taken from two different sites of every lesion, resulting in a total of 106 probes. Presence of each pathogen was determined by polymerase chain reaction, subsequent hybridization, and DNA sequencing.
  
  
  RESULTS
  Cytomegalovirus and C. pneumoniae were detected in 30 and 32% of the samples, respectively; H. pylori was not detectable. The pathogens were not homogeneously distributed. A concurrent infection with both pathogens was observed in five of 106 (5%) lesions and five of 53 (9%) patients. Restenotic lesions were more often found in specimens in which cytomegalovirus was detected (five of 16 versus two of 37). Patients with C. pneumoniae-positive coronary lesions more commonly presented with unstable angina.
  
  
  CONCLUSIONS
  Inhomogeneous infections with cytomegalovirus and C. pneumoniae of coronary atherosclerotic lesions are found to be prevalent when serial analysis is performed. Concurrent infection with both pathogens occurs coincidentally; however, possible clinical implications of this new observation and the pathogenic impact on atherosclerosis need further investigation.
authors.affiliation: Medical Clinic I, RWTH University Hospital, Aachen, Germany. p.radke@ic.ac.uk
authors.forename: P W
authors.initials: PW
authors.lastname: Radke
authors.forename: S
authors.initials: S
authors.lastname: Merkelbach-Bruse
authors.forename: B J
authors.initials: BJ
authors.lastname: Messmer
authors.forename: J
authors.initials: J
authors.lastname: vom Dahl
authors.forename: H
authors.initials: H
authors.lastname: Dörge
authors.forename: A
authors.initials: A
authors.lastname: Naami
authors.forename: G
authors.initials: G
authors.lastname: Vogel
authors.forename: S
authors.initials: S
authors.lastname: Handt
authors.forename: P
authors.initials: P
authors.lastname: Hanrath
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000382:microbiology; D016993:Chlamydophila pneumoniae / Q000302:isolation & purification*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000382:microbiology*; D003331:Coronary Vessels / Q000382:microbiology*; D003587:Cytomegalovirus / Q000302:isolation & purification*; D004691:Endarterectomy; D005260:Female; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies