Routine screening for Helicobacter pylori during hospitalization for acute myocardial infarction did not reduce the risk of upper gastrointestinal bleeding, according to a Swedish nationwide cluster-randomized trial presented at the European Society of Cardiology Congress 2025.
Among 18,466 patients with type 1 myocardial infarction (MI) admitted to 35 hospitals between November 2021 and January 2024, 299 bleeding events occurred during screening periods compared with 336 during nonscreening periods, translating to 16.8 vs 19.2 cases per 1,000 person-years. The difference was not statistically significant.
Secondary outcomes, including cardiovascular events and mortality, did not differ between groups.
Subgroup analyses suggested fewer bleeding events among patients with moderate to severe anemia, kidney impairment, or those discharged without proton pump inhibitors (PPIs) . These findings were exploratory and not adjusted for multiple comparisons.
Hospitals were grouped into 18 clusters and randomized in a crossover design: 1 year of routine screening with a urea breath test, a 2-month washout, then 1 year of usual care, or the reverse sequence. Patients were followed until January 2025.
During screening, 70% of patients were tested; 24% tested positive, and nearly all received eradication therapy. PPI use at admission was 25% in both groups. At discharge, PPIs were prescribed to 56% of the screening group and 49% of the nonscreening group. Patients had a median age of 71 years, 71% were men, and one in three had a history of MI. Revascularization was performed in more than 80% of both groups.
Investigators acknowledged limitations, including identification of bleeding events through registry codes without central adjudication, variation in PPI prescribing, and incomplete adherence to screening.
“Among unselected patients with acute myocardial infarction, routine H pylori screening did not significantly reduce the risk of upper gastrointestinal bleeding,” concluded corresponding author Robin Hofmann, MD, PhD, of the Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden, and colleagues.
Full disclosures can be found in the study.
Source: JAMA