Macrolide therapy for Chlamydia pneumoniae in the secondary prevention of coronary artery disease:: A meta-analysis of randomized controlled trials

Study Objective. As recent studies have shown that antibiotic therapy to eradicate Chlamydia pneumoniae may be beneficial in the secondary prevention of coronary artery disease, and studies to date may have lacked statistical power, we conducted a meta-analysis of randomized controlled trials to determine the role of antibiotic therapy in this patient population. Design. Systematic review and meta-analysis of randomized controlled trials. Patients. A total of 12,032 patients from nine studies. Measurements and Main Results. We searched MEDLINE, EMBASE, the Cochrane Controlled Trials Register; and abstracts of conference proceedings to identify pertinent studies. The random effects model was used to estimate a pooled relative risk. Heterogeneity was assessed using the bootstrap version of the Q statistic with 1000 replications. In total; we reviewed nine randomized controlled trials enrolling 12,032 patients; six enrolled patients with acute coronary syndrome, two enrolled patients with stable coronary artery disease, and one enrolled a mixed population. Compared with placebo, macrolide therapy was not associated with a significant reduction in any coronary event (relative risk [RR] 0.98, 95% confidence interval [CI] 0.88-1.08), myocardial infarction or angina (RR 0.89, 95% CI 0.68-1.16), or overall mortality (RR 0.95, 95% CI 0.81-1.12). Conclusion. Our results do not support routine use of antichlamydial therapy for secondary prevention of coronary events.