Roxithromycin in prevention of acute coronary syndrome associated with Chlamydia pneumoniae infection: a randomized placebo controlled trial.

The role of Chlamydia pneumoniae infection in precipitating acute coronary syndrome (ACS) is unclear. Some studies have indicated that intervention with macrolide antibiotics might reduce coronary events in patients with ACS. A double blind, randomized, placebo-control trial was conducted on 84 ACS patients. Patients were randomized to 30 days of treatment with roxithromycin (150 mg, twice daily) or matching placebo. The follow-up period was 90 days, and the primary clinical end point included cardiovascular death, unplanned revascularization and recurrent angina/MI. Anti-C. pneumoniae IgG positive in 24 of 43 (55.8%) patients in the roxithromycin group and 23 of 41 (56.1%) patients in the placebo group. Anti-C. pneumoniae IgA positive in 20 of 43 (46.5%) patients in the roxithromycin group and 13 of 41 (31.7%) patients in the placebo group. Thirty-three cardiac events occurred (2 cardiovascular deaths, 9 CABG, 12 PTCA and 10 recurrent angina/MI) with 17 events in the roxithromycin group and 16 events in the placebo group. There was no significant difference of cardiac events between the roxithromycin and placebo groups. The present study suggests that antibiotic therapy with roxithromycin is not associated with reduction of cardiac events as reported by other investigators. However, therapeutic interventions may need to be specifically targeted to a group of patients who are confirmed with chronic C. pneumoniae infection.

Percutaneous transluminal coronary angioplasty in the young patients--Siriraj Hospital's experience.

The aim of this study was to follow-up immediate and long term results of patients aged less than 40 years with CAD treated by PTCA. Primary end points were to record major coronary events, incidence and timing of restenosis and requirement of repeated revascularization after initial PTCA. Data was collected retrospectively from records of patients aged less than 40 years who underwent PTCA from Jan 1996 to June 1998 in Her Majesty Cardiac Center, Siriraj Hospital. Patients were followed up and data was collected regarding recurrent angina, major coronary events and results of repeated coronary angiography and revascularization if available. Out of 830 procedures performed for 325 patients, 30 patients (9%) were less than 40 years of age and comprised of 26 males (87%) and 4 females (13%). Eighteen patients (60%) had more than one risk factor. The most important risk factor was smoking (60%) followed by dyslipidaemia (47%) and family history of coronary artery disease (20%). DM was strikingly uncommon. 14 patients had single vessel disease and 16 patients had multiple vessel disease. Initial stenosis was 87.5 +/- 9.8 and residual stenosis was 17.8 +/- 10.8. PTCA failed for 5 lesions, overall success rate was 89 per cent. Stent was used for 12 lesions in 10 patients. There was no major complication during the procedure. Minor complications included non occlusive dissection in four cases and groin haematoma in three cases. The follow up ranged from 7-36 months with the median of 23 months. During follow up, there was no major cardiac event such as death, acute MI, congestive heart failure or cerebero-vascular accident. Eleven patients (37%) had sustained improvement without recurrent angina. Recurrent angina occurred in 19 patients (63%) after initial PTCA and second/third recurrent angina occurred in 5 patients. On repeated coronary angiography angiographic restenosis was seen in 10 patients (33%) after initial PTCA. Overall repeated revascularization was done twenty times for sixteen patients which included 4 CABGs and 16 PTCA. Twenty one patients (70%) showed sustained improvement after repeated PTCA and medications. Follow up results of PTCA in young patients showed sustained improvement but achieved at high rate of repeated revascularization.