Serologic markers for cytomegalovirus in acute coronary syndromes.
BACKGROUND
Several studies relate cytomegalovirus (CMV) infection to the development of atherosclerosis. Its influence in triggering acute coronary syndromes (ACS) is not known.


OBJECTIVE
We set out to identify a relationship between CMV infection, occurrence of ACS and prognosis.


METHODS
Serologic markers (IgM and IgG) for CMV were tested prospectively at admission and at 30 days, in patients (pts) admitted to our CCU for ACS. Serologic markers for CMV were also tested in a group of pts with stable coronary artery disease admitted for elective coronary angiography. A greater than two-fold elevation of IgG titer at 30 days was defined as reactivation/reinfection. At 30 days and six months, the composite endpoint of death, myocardial (re)infarction and re-admission for unstable angina was evaluated.


RESULTS
There were 60 pts with ACS in the study group (age 63 +/- 10 years, 75% male) and 31 pts in the control group (age 64 +/- 10 years, 71% male). On admission, 95% of the pts with ACS and 81% in the control group presented a positive IgG (p = 0.029). In the study group, at 30 days, the only pt with a 3-fold titer elevation had an endpoint. The percentage was 17% for the group with a > or = 2- and < 3-fold elevation and 11% in the group without reactivation (p = 0.034). At six months, 50% of the patients with a greater than 2-fold titer elevation and 15% of the remaining patients had an endpoint (p = 0.017). In the control group, at 30 days, 3 pts (10%) had a significant elevation in IgG titer, > or = 2- and < 3-fold, without endpoint.


CONCLUSIONS
In pts with ACS, we found a higher prevalence of serologic markers for CMV than in pts with stable coronary disease. An elevation in IgG titer for CMV was associated with a worse outcome at 30 days and six months.
Timóteo
Ana
A
Serviço de Cardiologia e Laboratório de Microbiologia, Hospital de Santa Cruz, Carnaxide. ana_timoteo@yahoo.com
Ferreira
Jorge
J
Paixão
Paulo
P
Aguiar
Carlos
C
Teles
Rui
R
Cardoso
Eduarda
E
Silva
José Aniceto
JA
Marques
Teresa
T
Seabra-Gomes
Ricardo
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000097:blood / Q000821:virology*; D000914:Antibodies, Viral / Q000097:blood; D003586:Cytomegalovirus Infections / Q000097:blood / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012698:Serologic Tests
D000914:Antibodies, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M