Abstract |
CONTEXT:
Although Chlamydia pneumoniae infection has been associated with the initiation
and progression of atherosclerosis, results of clinical trials investigating
antichlamydial antibiotics as adjuncts to standard therapy in patients
with coronary artery disease (CAD) have been inconsistent.
OBJECTIVE: To conduct a meta-analysis of clinical trials of antichlamydial
antibiotic therapy in patients with CAD.
DATA SOURCES: The MEDLINE and Cochrane Central Register of Controlled
Trials databases were searched from 1966 to April 2005 for English-language
trials of antibiotic therapy in patients with CAD. Bibliographies of retrieved
articles were searched for further studies. Presentations at major scientific
meetings (2003-2004) were also reviewed. Search terms included antibacterial
agents, myocardial infarction, unstable angina, and coronary arteriosclerosis.
STUDY SELECTION: Eligible studies were prospective, randomized, placebo-controlled
trials of antichlamydial antibiotic therapy in patients with CAD that
reported all-cause mortality, myocardial infarction, or unstable angina.
Of the 110 potentially relevant articles identified, 11 reports enrolling
19,217 patients were included.
DATA EXTRACTION: Included studies were reviewed to determine the number
of patients randomized, mean duration of follow-up, and end points. End
points of interest included all-cause mortality, myocardial infarction
(MI), and a combined end point of MI and unstable angina.
DATA SYNTHESIS: Event rates were combined using a random-effects model.
Antibiotic therapy had no impact on all-cause mortality among treated
vs untreated patients (4.7% vs 4.6%; odds ratio [OR], 1.02; 95% confidence
interval [CI], 0.89-1.16; P = .83), on the rates of MI (5.0% vs 5.4%;
OR, 0.92; 95% CI, 0.81-1.04; P = .19), or on the combined end point of
MI and unstable angina (9.2% vs 9.6%; OR, 0.91; 95% CI, 0.76-1.07; P =
.25).
CONCLUSION: Evidence available to date does not demonstrate an overall
benefit of antibiotic therapy in reducing mortality or cardiovascular
events in patients with CAD.
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