Infectious agents in coronary lesions obtained by endatherectomy: pattern of distribution, coinfection, and clinical findings

Background Cytomegalovirus (CMV), Chlamydia pneumoniae (C. pneumoniae), and Helicobacter pylori (H. pylori) have been implicated in atherosclerosis an d restenosis after angioplasty. The patterns of distribution within coronar y lesions and possible coinfections of these pathogens in the coronary vasc ulature had not previously been evaluated. Design A prospective, observational clinical study. Methods Large coronary specimens (9 -105 mm long) were obtained by endather ectomy of 53 patients undergoing aortocoronary bypass surgery. Samples were taken from two different sites of every lesion, resulting in a total of 10 6 probes. Presence of each pathogen was determined by polymerase chain reac tion, subsequent hybridization, and DNA sequencing. Results Cytomegalovirus and C. pneumoniae were detected in 30 and 32% of th e samples, respectively; H. pylori was not detectable. The pathogens were n ot homogeneously distributed. A concurrent infection with both pathogens wa s observed in five of 106 (5%) lesions and five of 53 (9%) patients. Resten otic lesions were more often found in specimens in which cytomegalovirus wa s detected (five of 16 versus two of 37). Patients with C. pneumoniae-posit ive coronary lesions more commonly presented with unstable angina. Conclusions Inhomogeneous infections with cytomegalovirus and C. pneumoniae of coronary atherosclerotic lesions are found to be prevalent when serial analysis is performed. Concurrent infection with both pathogens occurs coin cidentally; however, possible clinical implications of this new observation and the pathogenic impact on atherosclerosis need further investigation. C oron Artery Dis 12:1-6 (C) 2001 Lippincott Williams & Wilkins.