Azithromycin does not prevent six-month myointimal proliferation but attenuates the transient systemic inflammation occurring after coronary stenting.
OBJECTIVE
Stent implantation produces a systemic increase of inflammatory markers that correlates with Chlamydophila pneumoniae infection in atherosclerotic plaque. We performed a clinical intervention study to investigate the effect of antibiotic treatment on 6-month follow-up angiographic minimal luminal diameter after stenting.


METHODS
Ninety patients were randomly assigned to oral azithromycin or placebo in a double-blinded and randomized fashion. Medication was initiated 2 weeks before a pre-scheduled stenting procedure and maintained 12 weeks thereafter. Angiographic outcomes were evaluated by a six-month follow-up angiography and laboratorial parameters were accessed by blood sampling 2 weeks before stenting, within the first 24 h after procedure and additional samples after four weeks and 6 months.


RESULTS
Minimal luminal diameter (1.76 +/- 0.56 mm Vs. 1.70 +/- 0.86 mm; P = 0.7), restenosis rate, diameter stenosis, late loss, and binary restenosis rates were comparable in placebo and azithromycin group in the 6 months follow-up. Serum levels of C-reactive protein presented a three fold significant increase in the control group one day after stenting but did not change in the azithromycin group (8.5 [3.0;16.4] Vs. 2.9 [1.7;6.6]-median [25;75 percentile] P < 0.01).


CONCLUSIONS
Azithromycin does not improve late angiographic outcomes but attenuates the elevation of C-reactive protein levels after stenting, indicating an anti-inflammatory effect.
Center for Medical Research and Clinical Institute for Medical and Chemical Laboratory Diagnostics, Medical University Graz, Stiftingtalstrasse, 24, 8010, Graz, Austria.
Dimas T
DT
Ikeoka
Carolina Z
CZ
Vieira
Pedro A
PA
Lemos
Tania V
TV
Strabelli
Expedito E Ribeiro
EE
da Silva
Marco A
MA
Perin
Andrea
A
Groselj-Strele
Beate
B
Tiran
Andreas
A
Tiran
Bruno
B
Caramelli
D000284:Administration, Oral; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017963:Azithromycin / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000187:drug effects* / Q000378:metabolism; D049109:Cell Proliferation / Q000187:drug effects; D023521:Chlamydophila Infections / Q000209:etiology / Q000517:prevention & control; D016993:Chlamydophila pneumoniae / Q000302:isolation & purification; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000209:etiology; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome; D017539:Tunica Intima / Q000187:drug effects / Q000378:metabolism
D000900:Anti-Bacterial Agents; D017963:Azithromycin; D002097:C-Reactive Protein