(Circulation. 2000;102:1755.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Randomized Secondary Prevention Trial of Azithromycin in Patients With Coronary Artery Disease
Primary Clinical Results of the ACADEMIC Study
From the Department of Medicine, Division of Cardiology, University of Utah, LDS Hospital, Salt Lake City, Utah.
Correspondence to J. Brent Muhlestein, MD, Division of Cardiology, LDS Hospital, 8th Ave & C St, Salt Lake City, Utah, 84143. E-mail ldbmuhle{at}ihc.com
Background—Chlamydia pneumoniae is associated with coronary artery disease (CAD), although its causal role is uncertain. A small preliminary study reported a >50% reduction in ischemic events by azithromycin, an antibiotic effective against C pneumoniae, in seropositive CAD patients. We tested this prospectively in a larger, randomized, double-blind study.
Methods and Results—CAD patients (n=302) seropositive to C
pneumoniae (IgG titers 
1:16) were randomized to placebo or
azithromycin 500 mg/d for 3 days and then 500 mg/wk for 3 months. The
primary clinical end point included cardiovascular
death, resuscitated cardiac arrest, nonfatal myocardial infarction
(MI), stroke, unstable angina, and unplanned coronary
revascularization at 2 years. Treatment groups were
balanced, and azithromycin was generally well tolerated. During the
trial, 47 first primary events occurred (cardiovascular
death, 9; resuscitated cardiac arrest, 1; MI, 11; stroke, 3; unstable
angina, 4; and unplanned coronary
revascularization, 19), with 22 events in the
azithromycin group and 25 in the placebo group. There was no
significant difference in the 1 primary end point between the 2 groups
(hazard ratio for azithromycin, 0.89; 95% CI, 0.51 to 1.61;
P=0.74). Events included 9 versus 7 occurring within 6
months and 13 versus 18 between 6 and 24 months in the azithromycin and
placebo groups, respectively.
Conclusions—This study suggests that antibiotic therapy with
azithromycin is not associated with marked early reductions (50%) in
ischemic events as suggested by an initial published report.
However, a clinically worthwhile benefit (ie, 20% to 30%) is still
possible, although it may be delayed. Larger (several thousand
patient), longer-term (3 to 5 years) antibiotic studies are therefore
indicated.
Key Words: coronary disease • antibiotics • Chlamydia pneumoniae
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