Helicobacter pylori Screening After Acute Myocardial Infarction

作者：Robin Hofmann, Stefan James, Martin Sundqvist, Jonatan Wärme, Oskar Angerås, Joakim Alfredsson, David Erlinge, Gabriel Arefalk, Göran Arstad, Simon Blomberg, Ole Fröbert, Kristina Hambræus, Per Hellström, Jörg Lauermann, Matthias Lidin, Lars Lindhagen, Georgios Mourtzinis, Carolina Schoede, Erik Thunström, Birgitta Voldberg, Henrik Wagner, Ollie Östlund, Tomas Jernberg, Magnus Bäck · 发表于：JAMA · 年份：2025 · DOI：10.1001/jama.2025.15047 · 被引用次数：8 · 研究领域：Helicobacter pylori-related gastroenterology studies、Potassium and Related Disorders、Atrial Fibrillation Management and Outcomes

Importance: Upper gastrointestinal bleeding is common after myocardial infarction. Objective: To determine whether routine screening for Helicobacter pylori infection during hospitalization for myocardial infarction reduces bleeding events and improves clinical outcomes. Design, Setting, and Participants: A nationwide, open-label, 2-period, 2-sequence, cluster randomized, crossover clinical trial using a clinical registry for study population definition and data collection merged with national Swedish health data registries. From November 17, 2021, through January 17, 2024, thirty-five Swedish hospitals grouped into 18 clusters were randomized to a sequence of 1 year with routine H pylori screening of all patients with acute myocardial infarction followed by a washout period of 2 months before crossing over to 1 year with usual care or vice versa. Patients were followed up until January 17, 2025. Intervention: Routine addition of H pylori screening by urea breath test to standard care in all patients hospitalized for myocardial infarction during the screening periods. Main Outcome and Measure: Upper gastrointestinal bleeding, analyzed by a negative binomial model in the intention-to-treat population. Results: A total of 18 466 patients (median age, 71 years [IQR, 61-79], 13 138 males [71%]) with myocardial infarction were followed up: 9245 during the screening periods and 9221 during the nonscreening periods. At admission, 2284 during the screening periods and 2275 during the...