INCREASED INCIDENCE OF CHLAMYDIA SPECIES WITHIN THE CORONARY-ARTERIESOF PATIENTS WITH SYMPTOMATIC ATHEROSCLEROTIC VERSUS OTHER FORMS OF CARDIOVASCULAR-DISEASE

Objectives. The objectives of this study were to test prospectively fo r an association between Chlamydia and atherosclerosis by comparing th e incidence of the pathogen found within atherosclerotic plaques in pa tients undergoing directional coronary atherectomy with a variety of c ontrol specimens and comparing the clinical features between the group s. Background. Previous work has suggested an association between Chla mydia pneumoniae infection and coronary atherosclerosis, based on the demonstration of increased serologic titers and the detection of bacte ria within atherosclerotic tissue, but this association has not yet be en regarded as established. Methods. Coronary specimens from 90 sympto matic patients undergoing coronary atherectomy were tested for the pre sence of Chlamydia species using direct immunofluorescence, Control sp ecimens from 24 subjects without atherosclerosis (12 normal coronary s pecimens and 12 coronary specimens from cardiac transplant recipients with subsequent transplant-induced coronary disease) were also examine d. Results. Coronary atherectomy specimens were definitely positive in 66 (73%) and equivocally positive in 5 (6%), resulting in 79% of spec imens showing evidence for the presence of Chlamydia species within th e atherosclerotic tissue. In contrast, only 1 (4%) of 24 nonatheroscle rotic coronary specimens showed any evidence of Chlamydia. The statist ical significance of this difference is a p value <0.001. Transmission electron microscopy was used to confirm the presence of appropriate o rganisms in three of five positive specimens, No clinical factors exce pt the presence of a primary nonrestenotic lesion (odds ratio 3.0, p = 0.057) predicted the presence of Chlamydia. Conclusions. This high in cidence of Chlamydia only in coronary arteries diseased by atheroscler osis suggests an etiologic role for Chlamydia infection in the develop ment of coronary atherosclerosis that should be further studied.