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Prevalence of H. pylori among patients undergoing coronary angiography (The HP-DAPT prevalence study)
Karel Huard1, Kevin Haddad1, Yacine Saada1
1Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
Insights
Helicobacter pylori (H. pylori) screening is crucial for patients on aspirin therapy. This study found 36% of angiography patients had H. pylori, a key factor in gastrointestinal bleeding risk.
Area of Science:
- Cardiology
- Gastroenterology
- Infectious Disease
Background:
- Chronic aspirin therapy increases gastrointestinal (GI) bleeding risk.
- Patients with coronary artery disease (CAD) on dual antiplatelet therapy (DAPT) or dual pathway inhibition (DPI) face elevated GI bleeding risks.
- Helicobacter pylori (H. pylori) infection is a significant contributor to GI bleeding.
Purpose of the Study:
- To determine the prevalence of H. pylori infection in patients undergoing coronary angiography who are candidates for DAPT or DPI.
- To identify predictors of H. pylori seropositivity in this high-risk population.
Main Methods:
- Prospective observational study at a single center.
- Inclusion of 195 patients undergoing coronary angiography with potential need for DAPT or DPI.
- H. pylori serology testing and multivariable logistic regression analysis.
Main Results:
- 36% of patients tested positive for H. pylori infection.
- Independent predictors of H. pylori seropositivity included chronic kidney disease (OR 2.76) and chronic obstructive pulmonary disease (OR 2.52).
- Mean age of participants was 67 years; 50% had prior CAD, and 49% underwent coronary intervention.
Conclusions:
- A significant prevalence of H. pylori was observed in patients referred for angiography.
- Systematic H. pylori screening and eradication could substantially lower GI bleeding incidence in patients requiring DAPT or DPI.
- This highlights the importance of H. pylori management in cardiovascular patients at high risk for bleeding.
Abstract:
Helicobacter pylori (H. pylori) screening and treatment is recommended for patients on chronic aspirin (ASA) therapy to reduce the risk of gastrointestinal bleeding. Coronary artery disease patients requiring combination antithrombotic therapy (dual antiplatelet therapy; DAPT, or dual pathway inhibition; DPI) are at an even higher risk of GI bleeding. Therefore, we aimed to evaluate the prevalence of H. pylori among patients referred for angiography and likely to receive DAPT or DPI. This single-center prospective observational study recruited patients undergoing coronary angiography and with the possibility of requiring DAPT or DPI. All included patients underwent H. pylori serology testing. Multivariable logistic regression was performed to determine predictors of seropositivity. 195 patients were included in the analysis. Mean age was 67 years, 50% had known prior CAD, and 49% underwent coronary intervention. H. pylori serology was positive in 36%. Chronic kidney disease (odds ratio [OR] 2.76; 95% confidence interval [CI] 1.24 to 6.15; p = 0.01) and chronic obstructive pulmonary disease (OR 2.52; 95% CI 1.14 to 5.55; p = 0.02) history were independent predictors of H. pylori seropositivity. Given the clinically significant prevalence of H. pylori seropositivity among patients referred for angiography, systematic screening strategies and eradication of H. pylori could significantly reduce the incidence of GI bleeding in patients requiring DAPT or DPI.
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