Helicobacter pylori screening in clinical routine during hospitalization for acute myocardial infarction - 18/12/20
, Magnus Bäck, MD, PhD cRésumé |
Background |
Potent antithrombotic therapy has significantly improved prognosis for patients with acute myocardial infarction (AMI), however, at a price of increased bleeding risk. Chronic gastric infection with Helicobacter pylori (Hp) commonly causes upper gastrointestinal bleeding and is proposed as a risk factor for subsequent bleeding post AMI. The prevalence of active Hp in a current AMI population and the feasibility of Hp screening as part of routine clinical care are unclear.
Objective |
To determine the prevalence of active Hp infection in a contemporary AMI cohort and to establish the feasibility of Hp diagnosis as part of routine clinical MI care.
Design |
Multicenter, prospective cohort study.
Setting |
Two university hospitals in Stockholm, Sweden.
Participants |
Patients admitted for AMI between November 6, 2019 and April 4, 2020. After written informed consent, Hp diagnostics was performed with a bedside urea breath test (Diabact, Mayoly Spindler) incorporated into routine care during the hospitalization period.
Exposure |
Positive test for Hp infection.
Main outcomes and measures |
The primary outcome was the prevalence of Hp infection. Secondary aims included predictive factors in patient characteristics and outcomes which were obtained from linkage with national registries. Predefined subgroup analyses included stratification for proton pump inhibitor use and infarct type.
Results |
Three hundred and ten consecutive AMI patients (median age 67; 23% female; 41% ST-elevation MI [STEMI]) were enrolled. Overall, the Hp prevalence was 20% (95%CI, 15.5-24.7). Hp positive status was significantly more common in smokers compared with nonsmokers (36% vs 21%, respectively; P < .05) and in patients presenting with STEMI compared with Non-STEMI (26% vs 15%, respectively; P = .02). The latter observation remained significant after multivariable adjustment. After exclusion of 97 subjects with current proton pump inhibitor use, the Hp prevalence was 24% (95%CI, 18.9-31.0).
Conclusions |
Active Hp infection is common in a contemporary AMI population and may represent a modifiable risk factor for upper gastrointestinal bleeding, which has been hitherto disregarded. Hp screening as part of clinical routine during AMI hospitalization was feasible. A future randomized trial is needed to determine whether routine Hp screening and subsequent eradication therapy reduces bleeding complications and improves prognosis.
Key Points |
Question: Is Helicobacter pylori (Hp) infection sufficiently common in patients with acute myocardial infarction (AMI) to consider systematic screening, and can Hp diagnostics be performed during AMI hospitalization?
Findings: In this multicenter prospective cohort study of 310 consecutive AMI patients, Hp infection was established in at least 20% of patients. Infected patients were significantly more likely to be active smokers and to present with ST-elevation MI.
Meaning: Hp screening as part of clinical routine during AMI hospitalization was feasible. Given the high Hp prevalence detected, Hp diagnostics and eradication to reduce bleeding complications and to improve prognosis after AMI should be further investigated.
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| ClinicalTrials.gov Identifier: NCT04289012. |
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| Funding: The study received research grants from The Swedish Research Council (grant number 2019-00414), and the Swedish Heart-Lung Foundation (grant number 20190193). MB was supported by the Swedish Research Council (grant number 2019-01486), the Swedish Heart and Lung Foundation (grant number 20180571), King Gustaf V and Queen Victoria Freemason Foundation, and Region Stockholm (grant number 20170365). RH was supported by the Stockholm County Council (clinical postdoctoral appointment, grant number K 2017-4577) and the Swedish Heart Lung foundation (grant number 20180187). SCP was supported by the Professor Nanna Svartz Foundation. TJ reports research grants from Merck Sharp & Dohme and Novartis and that his employer (Karolinska Institutet) has received reimbursement from Astra-Zeneca, Bayer, Merck Sharp & Dohme, Novartis and Sanofi for lecturing and consulting. The sources of funding had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. RH and MB had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. |
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| Disclosure: Mayoly Spindler Laboratories generously supported the diagnostics in this study but had no role in: design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication |
Vol 231
P. 105-109 - janvier 2021 Retour au numéro
Article précédent
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