Published Online
on March 11, 2002

A more recent version of this article appeared on April 2, 2002

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Submitted on October 23, 2001
Revised on January 28, 2002
Accepted on January 28, 2002

Effect of 3 Months of Antimicrobial Treatment With Clarithromycin in Acute Non--Q-Wave Coronary Syndrome

Juha Sinisalo MD^*, Kimmo Mattila MD, Ville Valtonen MD, Olli Anttonen MD, Jukka Juvonen MD, John Melin MD, Helena Vuorinen-Markkola MD, Markku S. Nieminen MD, and for the Clarithromycin in Acute Coronary Syndrome Patients in Finland (CLARIFY) Study Group

From Helsinki University Central Hospital, Department of Medicine, Division of Cardiology (J.S., H.V.-M., M.S.N.), and Infectious Diseases (K.M., V.V.), Helsinki; Lahti Central Hospital (O.A.), Lahti; Kajaani Central Hospital (J.J.), Kajaani; and Jyväskylä Central Hospital (J.M.), Jyväskylä, Finland.

^* To whom correspondence should be addressed. E-mail: juha.sinisalo{at}hus.fi.

Background—Coronary artery disease, an inflammatory disease, may be caused by infection. We investigated whether the antibiotic clarithromycin would reduce morbidity and mortality in patients with acute non--Q-wave coronary syndrome.

Methods and Results—Altogether, 148 patients with acute non--Q-wave infarction or unstable angina were randomly assigned to receive double-blind treatment with either clarithromycin or placebo for 3 months. The primary end point was a composite of death, myocardial infarction, or unstable angina during treatment; the secondary end point was occurrence of any cardiovascular event during the entire follow-up period (average 555 days, range 138 to 924 days). There was a trend toward fewer patients meeting primary end-point criteria in the clarithromycin group than in the placebo group (11 versus 19 patients, respectively; risk ratio 0.54, 95% CI 0.25 to 1.14; P=0.10). By the end of the entire follow-up, 16 patients in the clarithromycin group and 27 in the placebo group had experienced a cardiovascular event (risk ratio 0.49, 95% CI 0.26 to 0.92; P=0.03).

Conclusions—Clarithromycin appears to reduce the risk of ischemic cardiovascular events in patients presenting with acute non--Q-wave infarction or unstable angina. No signs of this effect diminishing were observed during follow-up.

Key words: angina • coronary disease • infection

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