BACKGROUND: Coronary artery disease (CAD) is a leading cause of mortality and morbidity worldwide. Recent studies showed that atherosclerosis is an inflammatory disease; that an infection that may cause the disease is plausible. Chlamydia pneumoniae, being an infectious agent, has been linked to be an activator of inflammation and thus may lead to atherosclerosis giving rise to coronary artery disease. This study hopes to discuss the potential role of antibiotic treatment to patients with known CAD in reducing mortality and morbidity.
Objectives: To determine the effectiveness of administering antibiotics vs placebo in reducing cardiac events, mortality and morbidity among patients with coronary artery disease.
Search strategy: The English language randomized controlled trials were reviewed via a search in Medline, Ovid, and Proquest databases, published and reported from year 1980's up to present with the key words "antibiotics," "coronary artery disease," and "acute coronary artery disease." Likewise, cross reference was also done by doing searches on the relevant topics in the reference list of the mentioned articles.
Selection criteria: Randomized, double blinded, placebo-controlled trials on antibiotics for coronary artery disease.
Data collection : Two investigators independently assesses the selected articles for review. Odds ratio and ARR at 95 percent confidence interval were determined using the Review Manager.
RESULTS: Ten studies were reviewed to determine the number of patients randomized, mean follow up and end points. End points of interest like death, myocardial infarction (Ml), unstable angina (UA), and stroke were included in the primary and secondary end points. The study among post-Mi patients had no impact on reduction in primary end points with OR of 0.92; 95 percent Cl, .81-1.04; ARR of 1 percent at a p - value of 0.18. It likewise did not have impact on reduction in the primary end points among patients with chronic/stable coronary artery disease with OR 1; 95 percent Cl, 0.88-1.12; ARR at 0 percent; p value of 0.94. In acute ACS, the study did not show any reduction on primary end point (OR 0.88; 95 percent Cl, 0.75-1.03; p value 0.11) as well as on secondary end point (OR 0.96; 95 percent Cl, 0.72-1.28; p value 0.77).
CONCLUSIONS: This meta-analysis demonstrates that, based on evidence available, antichlamydial antibiotic therapy does not significantly improve major clinical outcomes in patients with CAD and at present cannot be recommended.