{"id":29285,"date":"2025-11-14T04:24:00","date_gmt":"2025-11-13T20:24:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=29285"},"modified":"2025-11-14T05:38:28","modified_gmt":"2025-11-13T21:38:28","slug":"jama%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e6%80%a5%e6%80%a7%e5%bf%83%e6%a2%97%e5%90%8e%e7%9a%84%e5%b9%bd%e9%97%a8%e8%9e%ba%e6%9d%86%e8%8f%8c%e7%ad%9b%e6%9f%a5","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=29285","title":{"rendered":"[JAMA\u53d1\u8868\u8bba\u6587]\uff1a\u6025\u6027\u5fc3\u6897\u540e\u7684\u5e7d\u95e8\u87ba\u6746\u83cc\u7b5b\u67e5"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Helicobacter pylori<\/em>\u00a0Screening After Acute Myocardial Infarction: The Cluster Randomized Crossover HELP-MI SWEDEHEART Trial<\/h1>\n\n\n\n

Robin\u00a0Hofmann,\u00a0Stefan\u00a0James,\u00a0Martin O.\u00a0Sundqvist,\u00a0et al<\/h3>\n\n\n\n

JAMA 2025;334;(13):1160-1169.\u00a0doi:10.1001\/jama.2025.15047<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  Does routine Helicobacter pylori<\/em> screening with urea breath test of patients with myocardial infarction reduce upper gastrointestinal bleeding events?<\/p>\n\n\n\n

Findings<\/strong>  In this nationwide, cluster randomized, crossover clinical trial involving 18\u202f466 patients with myocardial infarction from 35 Swedish hospitals, routine H pylori<\/em> screening did not significantly reduce the risk of upper gastrointestinal bleeding (incidence rate, 16.8 vs 19.2 events per 1000-person-years; rate ratio, 0.90), although a benefit among patients at higher risk of bleeding may exist.<\/p>\n\n\n\n

Meaning<\/strong>  Routine H pylori<\/em> screening with urea breath test in patients with myocardial infarction cannot be recommended.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>\u00a0\u00a0Upper gastrointestinal bleeding is common after myocardial infarction.<\/p>\n\n\n\n

Objective<\/strong>  To determine whether routine screening for Helicobacter pylori<\/em> infection during hospitalization for myocardial infarction reduces bleeding events and improves clinical outcomes.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  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<\/em> 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.<\/p>\n\n\n\n

Intervention<\/strong>  Routine addition of H pylori<\/em> screening by urea breath test to standard care in all patients hospitalized for myocardial infarction during the screening periods.<\/p>\n\n\n\n

Main Outcome and Measure<\/strong>  Upper gastrointestinal bleeding, analyzed by a negative binomial model in the intention-to-treat population.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0A total of 18\u202f466 patients (median age, 71 years [IQR, 61-79], 13\u202f138 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 nonscreening periods (both 24.7%) reported proton pump inhibitor use. During screening periods, 6480 patients (70%) had undergone testing, of those 1532 (23.6%) tested positive for\u00a0H pylori<\/em>. After a median follow-up of 1.9 years, 299 patients in the screening group (incidence rate, 16.8 events per 1000 person-years; cumulative hazard at 3 years, 4.1%) and 336 in the usual care group (incidence rate, 19.2 events per 1000 person-years; cumulative hazard at 3 years, 4.6%) experienced the primary end point of upper gastrointestinal bleeding (rate ratio [RR], 0.90; 95% CI, 0.77-1.05;\u00a0P<\/em>\u2009=\u2009.18). Predefined nonmultiplicity adjusted subgroup analyses showed a heterogeneous intervention effect; for no anemia (RR, 0.98; 95% CI, 0.80-1.21), mild anemia (RR, 0.64; 95% CI, 0.42-0.98), and moderate to severe anemia (RR, 0.44; 95% CI, 0.23-0.87;\u00a0P<\/em>\u00a0for interaction\u2009=\u2009.03).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  Among unselected patients with acute myocardial infarction, routine H pylori<\/em>screening did not significantly reduce the risk of upper gastrointestinal bleeding.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov Identifier: NCT05024864<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Helicobacter pylori\u00a0Screen […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29285"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=29285"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29285\/revisions"}],"predecessor-version":[{"id":29629,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29285\/revisions\/29629"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=29285"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=29285"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=29285"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}