Antibiotic Therapy After Acute Myocardial Infarction

Abstract

Background-Infection with Chlamydia pneumoniae is suspected to contribute to the pathogenesis of human atherosclerosis. We investigated whether treatment with the macrolide antibiotic roxithromycin would reduce mortality or morbidity in patients with an acute myocardial infarction. Methods and Results-Eight hundred seventy-two patients with an acute myocardial infarction (AMI) were randomly assigned to receive double-blind treatment with either 300 mg roxithromycin or placebo daily for 6 weeks. Primary end point was total mortality during 12-month follow-up. Four hundred thirty-three patients were treated with roxithromycin and 439 with placebo. With the exception of a higher proportion of patients suffering an anterior wall AMI (48.1% in the roxithromycin group versus 40.2% in the placebo group; Pϭ0.027) and a lower prevalence of chronic obstructive pulmonary disease in the roxithromycin group (3.5% versus 6.9%, Pϭ0.028), baseline characteristics, reperfusion therapy, and medical treatment were well balanced between the two groups. More patients in the roxithromycin group interrupted their study medication before completion of at least 4 weeks of treatment (78 of 433 [18%] versus 48 of 439 [11%]; Pϭ0.003; odds ratio, 1.8; 95% CI, 1.2 to 2.6). Follow-up at 12 months was achieved in 868 of 872 (99.5%) patients. Total mortality at 12 months was 6.5% (28 of 431) in the roxithromycin group compared with 6.0% (26 of 437) in the placebo group (odds ratio, 1.1; 95% CI, 0.6 to 1.9; Pϭ0.739). There were also no differences in the secondary combined end points at 12 months. Conclusions-Treatment of AMI patients with roxithromycin did not reduce event rates during 12 months of follow-up. Therefore, our findings do not support the routine use of antibiotic treatment with a macrolide in patients with AMI.

A meta-analysis of antibiotic use for the secondary prevention of cardiovascular diseases

“…Trial populations were slightly variable. Six trials were conducted among patients with stable coronary artery disease (10,(13)(14)(15)(16)(17) and six trials involved patients with acute coronary syndromes (18)(19)(20)(21)(22)(23). The remaining trial was conducted among patients scheduled to undergo coronary artery bypass graft surgery (24).…”

“…Three trials (10,13,14) included anti-Chlamydia immunoglobulin (Ig)G titres as part of their inclusion criteria. Trials examined the use of one of four different antibiotics: azithromycin (seven trials) (10,(13)(14)(15)(19)(20)(21), roxithromycin (two trials) (17,22), clarithromycin (three trials) (16,23,24) and gatifloxacin (one trial) (18).…”

Antibiotic Treatment of Atherosclerotic Cardiovascular Disease

“…With the publication in this issue of Circulation of a clinical trial of antibiotic treatment of patients after acute myocardial infarctions, 1 there are now 12 published clinical trials of antibiotic treatment for secondary prevention of atherosclerotic cardiovascular disease. [1][2][3][4][5][6][7][8][9][10][11][12] Two additional trials, not yet published, were presented at the 2002 Annual Scientific Sessions of the American College of Cardiology.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12] Two additional trials, not yet published, were presented at the 2002 Annual Scientific Sessions of the American College of Cardiology. They are Weekly Intervention with Zithromax for Atherosclerosis and its Related Disorders (WIZARD) and AZithromycin in Acute Coronary Syndromes (AZACS).…”

Chlamydophila pneumoniae

“…The ANTIBIO (Antibiotic Therapy in Acute Myocardial Infarction) study [104] found that a 6-week course of roxithromycin showed no benefits in 872 patients with acute myocardial infarction after a 1-year follow-up.…”