H. pylori screening following myocardial infarction does not reduce upper GI bleeding risk
Helicobacter pylori screening was associated with a lower risk of upper GI bleeding in patients with acute myocardial infarction who had moderate to severe anemia or kidney failure, suggesting that certain high-risk subgroups might benefit from targeted testing, the authors of a Swedish trial observed.
Routine Helicobacter pylori screening during hospitalization for acute myocardial infarction did not significantly reduce the risk of upper GI bleeding, a randomized trial in Sweden found.
Between November 2021 and January 2024, researchers randomized 35 Swedish hospitals to one year of routine H. pylori screening of all patients with acute myocardial infarction or one year of usual care. After a washout period of two months, the hospitals switched protocols. Of a total of 18,466 patients (median age, 71 years; 71% men), 9,245 were from the screening periods and 9,221 were from the nonscreening periods. Infection was diagnosed using a bedside 13C-urea breath test. About a quarter of patients (24.7% in each group) reported proton-pump inhibitor (PPI) use upon hospital admission. Findings were published by JAMA on Sept. 1.
During screening periods, 6,480 patients (70%) underwent H. pylori testing, and of those 1,532 (23.6%) tested positive. At a median follow-up point of 1.9 years, 299 patients in the screening group (incidence rate, 16.8 events per 1,000 person-years; cumulative hazard at three years, 4.1%) and 336 in the usual care group (incidence rate, 19.2 events per 1,000 person-years; cumulative hazard at three years, 4.6%) experienced upper GI bleeding (rate ratio [RR], 0.90 [95% CI, 0.77 to 1.05]; P=0.18).
A more complete summary of the study is available in the Sept. 3 ACP Hospitalist, a publication exclusive to ACP members.