Published online before print March 11, 2002, doi: 10.1161/01.CIR.0000012544.07696.1F
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(Circulation. 2002;105:1555.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Effect of 3 Months of Antimicrobial Treatment With Clarithromycin in Acute Non–Q-Wave Coronary Syndrome
From Helsinki University Central Hospital, Department of Medicine, Division of Cardiology (J.S., H.V.-M., M.S.N.), and Infectious Diseases (K.M., V.V.), Helsinki; Lahti Central Hospital (O.A.), Lahti; Kajaani Central Hospital (J.J.), Kajaani; and Jyväskylä Central Hospital (J.M.), Jyväskylä, Finland.
Correspondence to Juha Sinisalo, MD, Helsinki University Central Hospital, PO Box 340, FIN-00290 Helsinki, Finland. E-mail juha.sinisalo{at}hus.fi
Background— Coronary artery disease, an inflammatory disease, may be caused by infection. We investigated whether the antibiotic clarithromycin would reduce morbidity and mortality in patients with acute non–Q-wave coronary syndrome.
Methods and Results— Altogether, 148 patients with acute non–Q-wave infarction or unstable angina were randomly assigned to receive double-blind treatment with either clarithromycin or placebo for 3 months. The primary end point was a composite of death, myocardial infarction, or unstable angina during treatment; the secondary end point was occurrence of any cardiovascular event during the entire follow-up period (average 555 days, range 138 to 924 days). There was a trend toward fewer patients meeting primary end-point criteria in the clarithromycin group than in the placebo group (11 versus 19 patients, respectively; risk ratio 0.54, 95% CI 0.25 to 1.14; P=0.10). By the end of the entire follow-up, 16 patients in the clarithromycin group and 27 in the placebo group had experienced a cardiovascular event (risk ratio 0.49, 95% CI 0.26 to 0.92; P=0.03).
Conclusions— Clarithromycin appears to reduce the risk of ischemic cardiovascular events in patients presenting with acute non–Q-wave infarction or unstable angina. No signs of this effect diminishing were observed during follow-up.
Key Words: angina • coronary disease • infection
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