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Antibody levels against Chlamydia pneumoniae and outcome of roxithromycin therapy in patients with acute myocardial infarction

Results from a sub-study of the randomised Antibiotic Therapy in Acute Myocardial Infarction (ANTIBIO) trial

Antikörper gegen Chlamydia pneumoniae und roxithromycin Therapie bei Patienten mit einem akuten Myokardinfarkt—Ergebnisse einer Substudie der randomisierten Antibiotischen Therapie beim Akuten Myokardinfarkt (ANTIBIO) Studie

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Zusammenfassung.

Hintergrund:

Die Ergebnisse verschiedener Studien zur Prävention kardiovaskulärer Ereignisse mittels Behandlung durch Makrolid-Antibiotika die gegen eine C. pneumoniae Infektion gerichtet sind, waren kontrovers. Die vorliegende Arbeit untersucht verschiedene Testsysteme zum Nachweis einer C. pneumoniae Infektion sowie den Effekt einer Behandlung mit Roxithromycin bei Patienten nach einem akuten Myokardinfarkt (AMI) in Abhängigkeit von ihrem Serostatus gegen C. pneumoniae.

Methoden:

Wir analysierten das Blut von 160 Patienten der prospektiven randomisierten doppelblinden ANTIBIO-tische Therapie beim AMI (ANTIBIO-) Studie, die den Effekt einer Therapie mit Roxithromycin 300 mg/die über 6 Wochen bei Patienten mit AMI untersuchte. Anti-Chlamydia IgG-, IgA-, and IgM-Antikörper wurden mittels verschiedener Testsysteme bestimmt.

Ergebnisse:

Wir fanden eine gute Korrelation zwischen den beiden IgG und IgA Bestimmungsmethoden (r = 0,900, p < 0,001 und r = 0,878, p < 0,001), wobei es jedoch starke Unterschiede in der Prävalenz positiver Testergebnisse gab. Das führte zu nur moderaten Werten in der Konkordanzanalyse, ausgedrückt durch den Kappa Koeffizienten, für IgG κ = 0,611 (95% CI = 0,498– 0,724, p < 0,001) und für IgA κ = 0,431 (95% CI: 0,322–0,540, p < 0,001). Wir fanden keine Assoziation zwischen positiven C. pneumoniae Titern und der klinischen Ereignisrate während der 12-Monats-Nachbeobachtungsphase. Auch Patienten mit positiven C. pneumoniae Titern profitierten nicht von einer Roxithromycin Therapie (p = ns).

Schlussfolgerung:

In Abhängigkeit vom verwendeten Testsystem ergeben sich deutliche Unterschiede in der Prävalenz C. pneumoniae seropositiver Patienten. Die klinische Ereignisrate während der Nachbeobachtungszeit wurde weder durch den Serostatus gegen C. pneumoniae der Patienten, noch durch eine Behandlung mit Roxithromycin, unabhängig vom Serostatus, beeinflusst.

Summary.

Background:

Results of studies concerning prevention of cardiovascular disease by treatment with macrolide antibiotics targeting C. pneumoniae infection are still controversial. This study describes the results of different tests for infection with C. pneumoniae as well as the effect of treatment with roxithromycin in patients with acute myocardial infarction (AMI) in relation to their serostatus against C. pneumoniae.

Methods:

We analysed blood of 160 patients who came from the ANTIBIOtic therapy after an AMI (ANTIBIO-) study, a prospective, randomised, placebo-controlled, double-blind study to investigate the effect of roxithromycin 300 mg/OD for 6 weeks in patients with an AMI. Anti-Chlamydia IgG-, IgA-, and IgM-antibodies of these patients were analysed by means of different test systems.

Results:

There was a good correlation between the two IgG and IgA methods (r = 0.900, p < 0.001 and r = 0.878, p < 0.001, respectively), but marked differences in the prevalence of positive tests. This resulted in only moderate concordance values, as expressed by the Kappa coefficients, for IgG κ = 0.611 (95% CI = 0.498–0.724, p < 0.001) and for IgA κ = 0.431 (95% CI: 0.322–0.540, p < 0.001). No significant association between positive C. pneumonia titers and the combined clinical endpoint during the 12 month follow-up could be found. In all test systems used, patients with positive anti-C. pneumoniae titers did not benefit from roxithromycin therapy (p = ns).

Conclusion:

Depending on the test system used, there are large differences in the prevalence of anti-C. pneumoniae seropositive patients. Clinical events during the 12 month follow-up after AMI did not depend on serostatus against C. pneumoniae and treatment with roxithromycin did not influence these events, independently of the serostatus against C. pneumoniae. However, the power of this subgroup analysis was low to detect small but significant differences.

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Authors and Affiliations

  1. Herzzentrum Ludwigshafen, Kardiologie, Bremserstraße 79, 67063, Ludwigshafen, Germany

    R. Zahn*, K. E. Siegler, B. Frilling & J. Senges

  2. Institut für Mikrobiologie und Hygiene, Städt. Klinikum, Bremserstr. 79, 67063, Ludwigshafen, Germany

    U. Burkhardt* & U. Höffler

  3. Kreisklinik Dachau, Innere Medizin I, Krankenhausstr. 15, 85221, Dauchau, Germany

    M. Weber

  4. Med. Klinik 8-Kardiologie, Klinikum Nürnberg-Süd, Breslauerstr. 201, 90808, Nürnberg, Germany

    M. Gottwik

  5. Augusta-Kranken-Anstalt, Bergstraße 26, 44791, Bochum, Germany

    M. Wehr

  6. Klinikum Kempten Oberallgäu gGmbH, Innere Med. II, Memmingerstr. 50–52, 87439, Kempten, Germany

    F. Seidel

  7. Städtisches Klinikum, Auenweg, 06847, Dessau, Germany

    S. Rosocha

  8. Klinikum Lippe-Detmold, Kardiologie, Röntgenstr. 18, 32756, Detmold, Germany

    U. Tebbe

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  1. U. Burkhardt*
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  2. R. Zahn*
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  3. U. Höffler
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Correspondence to R. Zahn*.

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* Drs. Burkhardt and Zahn contributed equally to this work

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Burkhardt*, U., Zahn*, R., Höffler, U. et al. Antibody levels against Chlamydia pneumoniae and outcome of roxithromycin therapy in patients with acute myocardial infarction. Z Kardiol 93, 671–678 (2004). https://doi.org/10.1007/s00392-004-0113-1

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  • DOI: https://doi.org/10.1007/s00392-004-0113-1

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