Increased incidence of Chlamydi species within the coronary arteries of patients with symptomatic atherosclerotic versus other forms of cardiovascular disease

Objectives. The objectives of this study were to test prospectively for an association between Chlamydi and atherosclerosis by comparing the incidence of the pathogen found within atherosclerotic plaques in patients undergoing directional coronary atherectomy with variety of control specimens and comparing the clinical features between the groups. Background. Previous work has suggested an association between Chlamydi pneumoniae infection and coronary atherosclerosis, based on the demonstration of increased serologic titers and the detection of bacteri within atherosclerotic tissue, but this association has not yet been regarded as established. Methods. Coronary specimens from 90 symptomatic patients undergoing coronary atherectomy were tested for the presence of Chlamydi species using direct immunofluorescence. Control specimens from 24 subjects without atherosclerosis (12 normal coronary specimens and 12 coronary specimens from cardiac transplant recipients with subsequent transplant-induced coronary disease) were also examined. Results. Coronary atherectomy specimens were definitely positive in 66 (73%) and equivocally positive in 5 (6%), resulting in 79% of specimens showing evidence for the presence of Chlamydi species within the atherosclerotic tissue. In contrast, only 1 (4%) of 24 nonatherosclerotic coronary specimens showed any evidence of Chlamydia. The statistical significance of this difference is p value <0.001. Transmission electron macroscopy was used to confirm the presence of appropriate organisms in three of five positive specimens. No clinical factors except the presence of primary nonrestenotic lesion (odds ratio 3.0, P = 0.057) predicted the presence of Chlamydia. Conclusions. This high incidence of Chlamydi only in coronary arteries diseased by atherosclerosis suggests an etiologic role for Chlamydi infection in the development of coronary atherosclerosis that should be further studied.