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

## TL;DR

This study explores how Helicobacter pylori infection and its CagA protein may influence inflammation and outcomes in heart attack patients.

## Contribution

The study identifies novel inflammatory biomarkers associated with Helicobacter pylori infection in myocardial infarction patients.

## Key findings

- Patients with Helicobacter pylori had elevated CRP levels, suggesting inflammation.
- CCL20 and IGHG3 were higher, while TRAIL was lower in Helicobacter pylori-positive patients.
- Elevated CCL20 and reduced TRAIL were linked to worse cardiovascular outcomes and mortality.

## Abstract

Helicobacter pylori
(Hp) and its virulence factor Cytotoxin‐associated gene A (CagA) have been linked to myocardial infarction (MI), but the mechanisms are unknown. This study aims to test if Hp infection and CagA are associated with pre‐specified inflammatory and vascular biomarkers in patients with MI and to explore whether a broader biomarker panel can predict infection. Furthermore, it aims to investigate the association of Hp infection and biomarkers with major adverse cardiovascular events (MACE) and mortality.

Hp, CagA serology, and 175 cardiovascular biomarkers were analyzed in 1061 patients with MI admitted between 2008 and 2014. Associations between Hp and seven pre‐selected biomarkers were evaluated. Exploratory analyses included all biomarkers using machine‐learning models to predict Hp‐status. Hp‐status and the top predictors were analyzed for associations with outcomes using Cox regression.

Median age was 65 years; 78% were male. Hp and CagA seroprevalence were 45% and 19%, respectively. Patients with Hp had elevated CRP (β = 0.26, 95% CI 0.01–0.51). Predictive performance of Hp‐status was moderate (AUC 0.63–0.68). Exploratory analysis identified higher levels of C‐C motif chemokine ligand 20 (CCL20) and immunoglobulin heavy constant gamma‐3 (IGHG3), and lower levels of TNF‐related apoptosis‐inducing ligand (TRAIL) in patients with Hp‐positivity. Elevated CCL20 and reduced TRAIL, but not Hp, were associated with MACE and all‐cause mortality.

Hp may contribute to an inflammatory response in patients with MI, indicated by higher CRP and inflammatory/immune‐modulatory biomarkers emerging as its top predictors. Although Hp was not associated with adverse outcomes after MI, its predictive inflammatory biomarkers were associated with MACE and mortality.

The study was not registered as a clinical trial, as it was an observational study