HELP-MI SWEDEHEART Trial – H. pylori Screening in MI
HELP-MI SWEDEHEART Trial – H. pylori Screening in MI
Source: Brian Owens, JAMA / ESC Congress 2025, Sept 5, 2025
1. Background
• Upper GI bleeding is a common complication after MI.
• Linked to H. pylori infection and worsened by antithrombotic therapy.
2. Trial Design
• Cluster-randomized crossover, 18,000+ MI patients at 35 Swedish hospitals.
• Screening with urea breath test.
• Found: 10% reduction in GI bleeding risk, not statistically significant.
3. Limitations
• Only 70% of patients actually screened.
• H. pylori prevalence low (~23%).
• 25% already on PPIs in both arms.
4. High-Risk Subgroups
• Patients with anemia or kidney failure saw ~50% relative risk reduction.
• Numbers too small for statistical confirmation.
5. Interpretation
• Overall neutral, but clinically positive trends across subgroups.
• Experts suggest screening may benefit high-risk patients.
6. Implications
• Urea breath test + eradication therapy are simple, safe, inexpensive.
• Could be recommended in high-risk MI patients to reduce bleeding.
• Guideline committees will decide on adoption.
Take-home line:
“Routine H. pylori screening after MI shows no overall benefit, but may cut bleeding risk significantly in high-risk patients (e.g., anemia, kidney failure).”
