Ignite Creation Date:
2024-05-06 @ 2:19 PM
Last Modification Date:
2024-10-26 @ 1:29 PM
Study NCT ID:
NCT04289012
Status:
COMPLETED
Last Update Posted:
2021-01-12
First Post:
2020-02-23
Brief Title:
HELicobacter Pylori Screening in Patients With Acute Myocardial Infarction Pilot Study
Sponsor:
Karolinska Institutet
Organization:
Karolinska Institutet
Study Overview
Official Title:
HELicobacter Pylori Screening to Prevent Gastrointestinal Bleeding in Patients With Acute Myocardial Infarction Pilot Study
Status:
COMPLETED
Status Verified Date:
2021-01
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
HELPpilot
Brief Summary:
The aim of this study is to determine the prevalence of Helicobacter pylori Hp infection in patients with myocardial infarction MI This is performed to establish the feasibility of a large trial examining whether systematic screening for and subsequent eradication therapy significantly reduces the risk of hospitalization for upper gastrointestinal GI bleeding in patients after MI
Detailed Description:
Despite progressively reduced mortality over the last decades cardiovascular disease remains the most common cause of death in both men and women in Sweden and the world In addition to early revascularization therapy potent antithrombotic therapy is the basis for the reduction in cardiovascular events however at a price of increased risk of bleeding typically upper gastrointestinal bleeding UGIB that result in substantial morbidity mortality and medical care cost Risk factors for UGIB include high age male sex renal failure and a chronic bacterial infection caused by Helicobacter pylori Hp the latter being the only treatable H pylori infection causes both acute and chronic gastritis with ulcerative and erosive lesions peptic ulcer disease both duodenal and gastric ulcers and less commonly gastric cancer and mucosa-associated lymphoid tissue MALT lymphoma Concomitant anticoagulation or antithrombotic therapy aggravates the risk for bleeding 2-fold with low dose aspirin up to 7-fold with dual antiplatelet therapy which today is standard treatment for 12 months post MI
Non-invasive screening for Hp can be performed easily with high accuracy by urea breath or stool test If found positive eradication by triple therapy is well established and recommended in risk individuals and believed to reverse the bleeding risk almost completely
Hp screening in a current MI population has to our knowledge never been performed Thus it remains unknown if systematic screening and subsequent eradication therapy significantly reduces the risk of bleeding and improves prognosis
The HELicobacter Pylori Screening in Patients With Acute Myocardial Infarction HELP pilot study is a multicenter single group open-label clinical trial evaluating the prevalence of Hp in patients hospitalized with acute MI
All patients at participating sites during the inclusion period with MI diagnosis defined as International Classification of Diseases ICD codes I21 or I22 and age18 years are eligible for enrollment After written informed consent eligible patients will be tested for Hp infection with a bedside urea breath test UBT incorporated into MI routine care during the hospitalization period
The UBT is based on the fact that Hp produces urease which catalyzes the urea molecule into ammonia NH3 and carbon dioxide CO2 After fasting for six hours prior to testing the patient swallows a C13 Urea tablet or solution and waits After 10 minutes the patient exhales and breath is collected tube bag or breath card The production of 13CO2 is measured by a desktop analyzer infrared mass spectrometry and Hp diagnosis is made based on previously established cut-off levels for Hp infection
In patients tested positive standard triple eradication therapy according to the national society of gastroenterology guidelines will be prescribed at the caring physicians discretion
Control of successful Hp eradication therapy according to guidelines with either UBT or Hp-antigen in feces 6 weeks after completed eradication therapy is recommended to the treating physician
Baseline characteristics and data about the in-hospital period medication procedures complications laboratory results will be collected from the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated According to Recommended Therapies SWEDEHEART registry For patients with acute MI 106 variables are registered including demographics risk factors past medical history medical treatment before admission electrocardiographic changes echocardiography biochemical markers other clinical features and investigations medical treatment in hospital interventions hospital outcome discharge diagnoses and discharge-medications
Primary objective of this pilot study is to determine the prevalence of Hp infection in patients with MI
The secondary objective is to determine the feasibility of a large clinical trial on whether systematic screening for Hp and subsequent eradication therapy in patients after MI reduces UGIB and cardiovascular events
The tertiary objective is to map if the cardiovascular risk profile differs in patients that are Hp negative and Hp positive respectively
All-cause death within 30 days will be obtained from the Swedish population registry including the vital status of all Swedish residence SWEDEHEART is linked to the Swedish population registry every month
Non-invasive screening for Hp can be performed easily with high accuracy by urea breath or stool test If found positive eradication by triple therapy is well established and recommended in risk individuals and believed to reverse the bleeding risk almost completely
Hp screening in a current MI population has to our knowledge never been performed Thus it remains unknown if systematic screening and subsequent eradication therapy significantly reduces the risk of bleeding and improves prognosis
The HELicobacter Pylori Screening in Patients With Acute Myocardial Infarction HELP pilot study is a multicenter single group open-label clinical trial evaluating the prevalence of Hp in patients hospitalized with acute MI
All patients at participating sites during the inclusion period with MI diagnosis defined as International Classification of Diseases ICD codes I21 or I22 and age18 years are eligible for enrollment After written informed consent eligible patients will be tested for Hp infection with a bedside urea breath test UBT incorporated into MI routine care during the hospitalization period
The UBT is based on the fact that Hp produces urease which catalyzes the urea molecule into ammonia NH3 and carbon dioxide CO2 After fasting for six hours prior to testing the patient swallows a C13 Urea tablet or solution and waits After 10 minutes the patient exhales and breath is collected tube bag or breath card The production of 13CO2 is measured by a desktop analyzer infrared mass spectrometry and Hp diagnosis is made based on previously established cut-off levels for Hp infection
In patients tested positive standard triple eradication therapy according to the national society of gastroenterology guidelines will be prescribed at the caring physicians discretion
Control of successful Hp eradication therapy according to guidelines with either UBT or Hp-antigen in feces 6 weeks after completed eradication therapy is recommended to the treating physician
Baseline characteristics and data about the in-hospital period medication procedures complications laboratory results will be collected from the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease Evaluated According to Recommended Therapies SWEDEHEART registry For patients with acute MI 106 variables are registered including demographics risk factors past medical history medical treatment before admission electrocardiographic changes echocardiography biochemical markers other clinical features and investigations medical treatment in hospital interventions hospital outcome discharge diagnoses and discharge-medications
Primary objective of this pilot study is to determine the prevalence of Hp infection in patients with MI
The secondary objective is to determine the feasibility of a large clinical trial on whether systematic screening for Hp and subsequent eradication therapy in patients after MI reduces UGIB and cardiovascular events
The tertiary objective is to map if the cardiovascular risk profile differs in patients that are Hp negative and Hp positive respectively
All-cause death within 30 days will be obtained from the Swedish population registry including the vital status of all Swedish residence SWEDEHEART is linked to the Swedish population registry every month
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None