Routine H pylori screening in acute MI patients of no benefit

Routine screening for Helicobacter pylori infection in patients with acute myocardial infarction (MI) does not help lower the risk of upper gastrointestinal bleeding, according to a crossover trial.

The study included 18,466 acute MI patients (median age 71 years, 71 percent male). These patients were randomly assigned to undergo routine H pylori screening by urea breath test (n=9,245) or to receive usual care without screening (n=9,221) for 1 year. Following a washout period of 2 months, the patients crossed over to the alternative intervention.

At baseline, 2,284 patients during the screening periods and 2,275 during the nonscreening periods (both 24.7 percent) reported proton pump inhibitor use. A total of 6,480 patients (70 percent) completed testing during the screening periods, of which 1,532 (23.6 percent) tested positive for H pylori.

Over a median follow-up of 1.9 years, the primary endpoint of upper gastrointestinal bleeding occurred in 299 patients in the screening group and in 366 in the usual care group. The corresponding incidence rates were 16.8 and 19.2 events per 1,000 person-years, with the difference not statistically significant (rate ratio [RR], 0.90, 95 percent confidence interval [CI], 0.77–1.05; p=0.18).

In subgroup analyses, screening appeared to have a beneficial effect on the primary endpoint for patients with anaemia, with the effect being more pronounced for those with increased anaemia severity (no anaemia: RR, 0.98, 95 percent CI, 0.80–1.21; mild anaemia: RR, 0.64, 95 percent CI, 0.42–0.98; moderate to severe anaemia: RR, 0.44, 95 percent CI, 0.23–0.87; p=0.03 for interaction).