title: Serologic markers of persistent Chlamydia pneumonia infection and long-term prognosis after successful coronary stenting.
abstract: BACKGROUND
  Previous studies have shown an incremental role of inflammation in late prognosis following coronary stenting (CS). In particular, high preprocedural levels of plasma C-reactive protein (CRP) have been related to increased hazard of late ischemic complications. Persistent Chlamydia pneumoniae (Cp) infection, detected by positive IgA anti-Cp titers, may be associated with this inflammatory process and portend a high risk of late adverse prognosis after CS.
  
  
  METHODS
  A total of 483 consecutive patients with either stable or unstable coronary syndromes were followed-up for 1 year after successful CS. The composite of cardiac death, myocardial infarction, rehospitalization for rest-unstable angina, and exertional angina, whichever occurred first, was the clinical end point. Additionally, the rate of in-stent restenosis and progression of coronary artery disease during this period were evaluated. Anti-Cp titers and plasma CRP levels were measured before the procedure.
  
  
  RESULTS
  Positive immunoglobulin A (IgA), but not positive immunoglobulin G (IgG), titers were significantly associated with high plasma CRP levels in patients with unstable coronary syndromes (P =.005), but not in those with stable angina (P =.7). Moreover, positive IgA titers were significantly related to increased risk of both the composite clinical end point (P =.04) and progression of coronary artery disease (P <.001) in patients with unstable coronary syndromes but not in those with stable angina. Neither positive IgA nor positive IgG titers were associated with the rate of in-stent restenosis.
  
  
  CONCLUSIONS
  Persistent Cp infection may drive an inflammatory response in the coronary vasculature and portends an adverse late outcome after CS in patients with unstable coronary syndromes.
authors.affiliation: Department of Cardiology, Tzanio Hospital, Piraeus, Greece. zairis@hellasnet.gr
authors.forename: Michael N
authors.initials: MN
authors.lastname: Zairis
authors.forename: Olga A
authors.initials: OA
authors.lastname: Papadaki
authors.forename: Paraskevi K
authors.initials: PK
authors.lastname: Psarogianni
authors.forename: Maria A
authors.initials: MA
authors.lastname: Thoma
authors.forename: George K
authors.initials: GK
authors.lastname: Andrikopoulos
authors.forename: Pelagia C
authors.initials: PC
authors.lastname: Batika
authors.forename: Christina G
authors.initials: CG
authors.lastname: Poulopoulou
authors.forename: Kyriaki G
authors.initials: KG
authors.lastname: Trifinopoulou
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Olympios
authors.forename: Stefanos G
authors.initials: SG
authors.lastname: Foussas
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000787:Angina Pectoris / Q000097:blood / Q000382:microbiology / Q000628:therapy; D000907:Antibodies, Bacterial / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D002690:Chlamydia Infections; D016993:Chlamydophila pneumoniae / Q000276:immunology*; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood* / Q000382:microbiology / Q000628:therapy; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000382:microbiology / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D015607:Stents; D013577:Syndrome
chemical_list: D000907:Antibodies, Bacterial; D015415:Biomarkers; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D002097:C-Reactive Protein