Serologic markers of persistent Chlamydia pneumonia infection and long-term prognosis after successful coronary stenting.
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.
Zairis
Michael N
MN
Department of Cardiology, Tzanio Hospital, Piraeus, Greece. zairis@hellasnet.gr
Papadaki
Olga A
OA
Psarogianni
Paraskevi K
PK
Thoma
Maria A
MA
Andrikopoulos
George K
GK
Batika
Pelagia C
PC
Poulopoulou
Christina G
CG
Trifinopoulou
Kyriaki G
KG
Olympios
Christopher D
CD
Foussas
Stefanos G
SG
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
D000907:Antibodies, Bacterial; D015415:Biomarkers; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D002097:C-Reactive Protein