Antibiotic Treatment of Chlamydia pneumoniae after Acute Coronary

Antibiotic Treatment of Chlamydia pneumoniae after Acute Coronary Syndrome Christopher P. Cannon, M. D. , Eugene Braunwald, M. D. , Carolyn H. Mc. Cabe, B. S. , J. Thomas Grayston, M. D. , Brent Muhlestein, M. D. , Robert P. Giugliano, M. D. , Richard Cairns, M. Sc. , Allan M. Skene, Ph. D. and the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 Investigators N Engl J Med Volume 352; 16: 1646 -1654 April 21, 2005

Study Overview • Studies have suggested that infection with Chlamydia pneumoniae may have a role in the pathogenesis of coronary artery disease • This study casts doubt on the idea, since two years of treatment with gatifloxacin, an antibiotic with bactericidal activity against C • pneumoniae, had no beneficial effect on clinical outcomes • This study complements the results of the study by Grayston et al • reported in this issue of the Journal, which led to a similar conclusion

Numbers of Patients Who Were Randomly Assigned to a Treatment Group, Who Started the Assigned Treatment, and Who Discontinued Treatment or Were Lost to Follow-up Cannon, C. et al. N Engl J Med 2005; 352: 1646 -1654

Baseline Characteristics of the Patients Cannon, C. et al. N Engl J Med 2005; 352: 1646 -1654

Kaplan-Meier Estimates of Events over Time among Patients Treated with Gatifloxacin or Placebo Cannon, C. et al. N Engl J Med 2005; 352: 1646 -1654

Risk Reduction for Death or a Major Cardiovascular Event and Event Rates at Two Years Cannon, C. et al. N Engl J Med 2005; 352: 1646 -1654

Hazard Ratios for Death or a Major Cardiovascular Event, with Two-Year Event Rates, According to Baseline Characteristics Cannon, C. et al. N Engl J Med 2005; 352: 1646 -1654

Conclusions • Despite long-term treatment with a bactericidal antibiotic effective against C • pneumoniae, no reduction in the rate of cardiovascular events was observed