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
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
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