{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T07:11:32Z","timestamp":1793085092068,"version":"4.5.0"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"13","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2025,10,7]]},"abstract":"\n Importance<\/jats:title>\n Upper gastrointestinal bleeding is common after myocardial infarction.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n To determine whether routine screening for\n Helicobacter pylori<\/jats:italic>\n infection during hospitalization for myocardial infarction reduces bleeding events and improves clinical outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n \n 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\n H pylori<\/jats:italic>\n 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.\n <\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n \n Routine addition of\n H pylori<\/jats:italic>\n screening by urea breath test to standard care in all patients hospitalized for myocardial infarction during the screening periods.\n <\/jats:p>\n <\/jats:sec>\n \n Main Outcome and Measure<\/jats:title>\n Upper gastrointestinal bleeding, analyzed by a negative binomial model in the intention-to-treat population.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A 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\n H pylori<\/jats:italic>\n . 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;\n P<\/jats:italic>\n \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;\n P<\/jats:italic>\n for interaction\u2009=\u2009.03).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n \n Among unselected patients with acute myocardial infarction, routine\n H pylori<\/jats:italic>\n screening did not significantly reduce the risk of upper gastrointestinal bleeding.\n <\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT05024864<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2025.15047","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T07:30:17Z","timestamp":1756711817000},"page":"1160","source":"Crossref","is-referenced-by-count":11,"title":["Helicobacter pylori<\/i>\n Screening After Acute 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