Effect of Helicobacter pylori treatment on gastrointestinal bleeding within 12 months after percutaneous coronary intervention in patients with acute myocardial infarction – A nationwide population-based study

Aims There is insufficient evidence to support H. pylori treatment (HPT) for gastrointestinal bleeding (GIB) in patients taking dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI). Therefore, the purpose of this study was to evaluate the effect of HPT performed after PCI on the occurrence of gastrointestinal bleeding (GIB) and major adverse cardiovascular events (MACE).

Methods Patients who underwent PCI for acute myocardial infarction (AMI) from January 1, 2002 to December 31, 2018, were searched through disease classification code analysis from the National Health Insurance Service claims data, and antiplatelet drugs administered with aspirin were investigated by searching Drug claims data. Among them, patients who underwent endoscopic hemostasis for GIB within 12 months after PCI were investigated to see if HPT prescribed before or after endoscopic hemostasis was related with gastrointestinal rebleeding. We also investigated the influence of HPT on MACE and deaths within 12 months after PCI [1].

Results A total of 12,247 patients underwent PCI for AMI extracted from the cohort. Among them, 10,529 patients took DAPT within 1 year after PCI. A total of 918 patients (8.7%) experienced GIB during the first 12 months of DAPT administration after PCI, of which 570 (62.0%) underwent endoscopic hemostasis. After endoscopic hemostasis, 254 patients (44.5%) received HPT. The incidence of GIB after taking DAPT increased significantly from 6 months after the start of DAPT administration. In addition, as for duration of DAPT administration, the occurrence of GIB was significantly higher at 12 months of administration than at 6 months of administration (Log rank P=0.001).

As for all-cause of mortality rates, the 6-month DAPT group had a significantly higher all-cause mortality rate than the 12-month DAPT group (Log rank P<0.001). Furthermore, the 6-month DAPT group had significantly higher cardiovascular mortality than the 12-month DAPT group (Log rank P<0.001). As for the risk of GI rebleeding, there were no significant differences between the HPT group and non-HPT group after endoscopic hemostasis. Especially, the HPT group had a significantly lower rebleeding rate than the non-HPT group (Log rank P<0.001).

Conclusions In patients taking DAPT after PCI due to AMI, ‘test-and-treat’ for H. pylori may prevent recurrent GIB.

Publikationsverlauf

Artikel online veröffentlicht:
27. März 2025

• References

• 1 Kowalski M, Konturek PC, Pieniazek P, Karczewska E, Kluczka A, Grove R, Kranig W, Nasseri R, Thale J, Hahn EG, Konturek SJ.. Prevalence of Helicobacter pylori infection in coronary artery disease and effect of its eradication on coronary lumen reduction after percutaneous coronary angioplasty. Dig Liver Dis 2001; 33 (03): 222-9