Helicobacter pylori, Inflammation, and Long-Term Outcome in Patients With Acute Myocardial Infarction: A Prospective Cohort Study.

Helicobacter pylori and CagA seroprevalence were 45% and 19%, respectively, in patients with acute myocardial infarction.

• Study included 1061 patients with MI admitted between 2008 and 2014.
• Median age was 65 years; 78% were male.
• Hp seroprevalence was 45% and CagA seroprevalence was 19%.
• Hp and CagA serology were analyzed alongside 175 cardiovascular biomarkers.

Patients with Hp infection had elevated CRP levels compared to Hp-negative patients.

• The association between Hp positivity and CRP was statistically significant (β = 0.26, 95% CI 0.01–0.51).
• CRP was one of seven pre-selected inflammatory and vascular biomarkers evaluated for association with Hp status.
• This finding suggests Hp may contribute to a systemic inflammatory response in MI patients.

Machine-learning models showed moderate predictive performance for Hp-status using the full biomarker panel.

• Area under the curve (AUC) for predicting Hp-status ranged from 0.63 to 0.68.
• Exploratory analyses included all 175 biomarkers using machine-learning models.
• Performance was described as moderate, indicating the biomarker panel partially but incompletely captures Hp infection status.

Exploratory analysis identified CCL20, IGHG3, and TRAIL as top biomarker predictors of Hp positivity.

• Higher levels of C-C motif chemokine ligand 20 (CCL20) were found in Hp-positive patients.
• Higher levels of immunoglobulin heavy constant gamma-3 (IGHG3) were found in Hp-positive patients.
• Lower levels of TNF-related apoptosis-inducing ligand (TRAIL) were found in Hp-positive patients.
• These biomarkers were identified through exploratory analysis of all 175 cardiovascular biomarkers.

Elevated CCL20 and reduced TRAIL were associated with MACE and all-cause mortality, but Hp infection itself was not.

• Hp-status was not independently associated with major adverse cardiovascular events (MACE) or all-cause mortality.
• Elevated CCL20 was associated with both MACE and all-cause mortality in Cox regression analyses.
• Reduced TRAIL was associated with both MACE and all-cause mortality in Cox regression analyses.
• IGHG3 association with outcomes was not highlighted among significant predictors.
• Hp-status and top predictive biomarkers were analyzed for outcomes using Cox regression.

Hp infection was associated with inflammatory and immune-modulatory biomarker profiles in MI patients, suggesting a role in systemic inflammation.

• Higher CRP levels and inflammatory/immune-modulatory biomarkers (CCL20, IGHG3, lower TRAIL) emerged as top predictors of Hp positivity.
• The authors concluded that 'Hp may contribute to an inflammatory response in patients with MI.'
• CagA, the virulence factor of Hp, had a seroprevalence of 19% in this cohort.
• The study design was a prospective cohort study of MI patients.