Antibody levels against Chlamydia pneumoniae and outcome of roxithromycin therapy in patients with acute myocardial infarction. Results from a sub-study of the randomised Antibiotic Therapy in Acute Myocardial Infarction (ANTIBIO) trial.
BACKGROUND
Results of studies concerning prevention of cardiovascular disease by treatment with macrolide antibiotics targeting C. pneumoniae infection are still controversial. This study describes the results of different tests for infection with C. pneumoniae as well as the effect of treatment with roxithromycin in patients with acute myocardial infarction (AMI) in relation to their serostatus against C. pneumoniae.


METHODS
We analysed blood of 160 patients who came from the ANTIBIOtic therapy after an AMI ( ANTIBIO-) study, a prospective, randomised, placebo-controlled, double-blind study to investigate the effect of roxithromycin 300 mg/OD for 6 weeks in patients with an AMI. Anti- Chlamydia IgG-, IgA-, and IgM-antibodies of these patients were analysed by means of different test systems.


RESULTS
There was a good correlation between the two IgG and IgA methods (r = 0.900, p < 0.001 and r = 0.878, p < 0.001, respectively), but marked differences in the prevalence of positive tests. This resulted in only moderate concordance values, as expressed by the Kappa coefficients, for IgG kappa = 0.611 (95% CI = 0.498-0.724, p < 0.001) and for IgA kappa = 0.431 (95% CI: 0.322-0.540, p < 0.001). No significant association between positive C. pneumonia titers and the combined clinical endpoint during the 12 month follow-up could be found. In all test systems used, patients with positive anti- C. pneumoniae titers did not benefit from roxithromycin therapy (p = ns).


CONCLUSIONS
Depending on the test system used, there are large differences in the prevalence of anti- C. pneumoniae seropositive patients. Clinical events during the 12 month follow-up after AMI did not depend on serostatus against C. pneumoniae and treatment with roxithromycin did not influence these events, independently of the serostatus against C. pneumoniae. However, the power of this subgroup analysis was low to detect small but significant differences.
Burkhardt
U
U
Institut für Mikrobiologie und Hygiene, Städt. Klinikum, Bremserstr. 79, 67063 Ludwigshafen, Germany.
Zahn
R
R
Höffler
U
U
Siegler
K E
KE
Frilling
B
B
Weber
M
M
Gottwik
M
M
Wehr
M
M
Seidel
F
F
Rosocha
S
S
Tebbe
U
U
Senges
J
J
D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000907:Antibodies, Bacterial / Q000097:blood*; D016009:Chi-Square Distribution; D023521:Chlamydophila Infections / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D016993:Chlamydophila pneumoniae / Q000276:immunology*; D003168:Complement Fixation Tests; D003627:Data Interpretation, Statistical; D004311:Double-Blind Method; D004562:Electrocardiography; D005500:Follow-Up Studies; D006801:Humans; D007124:Immunoenzyme Techniques; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D007075:Immunoglobulin M / Q000097:blood; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D010919:Placebos; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D015575:Roxithromycin / Q000008:administration & dosage / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D010919:Placebos; D015575:Roxithromycin