Baker William L, Couch Kimberly A
School of Pharmacy, University of Connecticut, Storrs, and Division of Cardiology, Hartford Hospital 06102, USA.
Am J Health Syst Pharm. 2007 Apr 15;64(8):830-6. doi: 10.2146/ajhp060539.
A meta-analysis of randomized, controlled trials that evaluated the effect of the macrolide antibiotic, azithromycin, on clinical outcomes in patients with coronary artery disease (CAD) was conducted.
A systematic literature search of MEDLINE, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews was conducted using specific search terms. Randomized, controlled trials comparing azithromycin or placebo in secondary CAD patients with adequately reported data on mortality and clinical cardiac endpoints were included. A random-effects model was used.
Six studies (n=13,778) met the inclusion criteria. The trials varied in their design. On meta-analysis, azithromycin resulted in a nonsignificant reduction in mortality versus placebo (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.77-1.09; p=0.31). Four trials reported the rate of nonfatal myocardial infarction (MI). Azithromycin did not have an effect on the rate of nonfatal MI versus placebo (OR, 0.95; 95% CI, 0.80-1.13; p=0.57). Five trials reported rates of hospitalization in which no significant difference was seen with azithromycin versus placebo (OR, 0.97; 95% CI, 0.80-1.17; p=0.76). Six trials were used to evaluate the composite cardiovascular endpoint. Again, no significant benefit was seen with azithromycin versus placebo (OR, 0.93; 95% CI, 0.84-1.03; p=0.218).
Meta-analysis showed that azithromycin does not appear to reduce the frequency of recurrent cardiac events in patients with CAD. Results from ongoing trials may clarify the role of azithromycin in the secondary prevention of coronary events.
对评估大环内酯类抗生素阿奇霉素对冠心病（CAD）患者临床结局影响的随机对照试验进行荟萃分析。
使用特定检索词对MEDLINE、EMBASE、科学网和Cochrane系统评价数据库进行系统文献检索。纳入在继发性CAD患者中比较阿奇霉素或安慰剂且有充分报告的死亡率和临床心脏终点数据的随机对照试验。采用随机效应模型。
六项研究（n = 13778）符合纳入标准。试验设计各不相同。荟萃分析显示，与安慰剂相比，阿奇霉素导致死亡率非显著性降低（优势比[OR]，0.91；95%置信区间[CI]，0.77 - 1.09；p = 0.31）。四项试验报告了非致命性心肌梗死（MI）发生率。与安慰剂相比，阿奇霉素对非致命性MI发生率无影响（OR，0.95；95% CI，0.80 - 1.13；p = 0.57）。五项试验报告了住院率，阿奇霉素与安慰剂相比无显著差异（OR，0.97；95% CI，0.80 - 1.17；p = 0.76）。六项试验用于评估复合心血管终点。同样，与安慰剂相比，阿奇霉素未显示出显著益处（OR，0.93；95% CI，0.84 - 1.03；p = 0.218）。
荟萃分析表明，阿奇霉素似乎并未降低CAD患者复发性心脏事件的发生率。正在进行的试验结果可能会阐明阿奇霉素在冠状动脉事件二级预防中的作用。
