BACKGROUND: Cytotoxin-associated gene antigen (CagA)-positive strains of Helicobacter pylori have previously been associated with acute coronary syndromes. However, the role of CagA-positive strains of Helicobacter pylori in recurring cardiac events after ST-segment elevation myocardial infarction (STEMI) has not yet been assessed. METHODS: We enrolled 181 consecutive patients (155 men, mean age 64±13 years) presenting with STEMI. In all patients, serum levels of IgG anti-CagA were assessed. Levels of IgG anti-hepatitis A virus were also evaluated in all patients in order to exclude the presence of a bystander activation of the immune system. Finally, a previous history of acute coronary syndrome and the rate of major adverse cardiovascular events as a composite of cardiovascular death, recurring myocardial infarction and target lesion revascularisation within 2 years follow-up were evaluated. RESULTS: Anti-CagA IgG seropositive patients presented more frequently with a previous history of acute coronary syndrome compared with seronegative patients (28.3% vs. 14%, P=0.019). Interestingly, no differences were observed between anti-CagA IgG seropositive and anti-CagA IgG seronegative patients concerning the prevalence of anti-hepatitis A virus IgG seropositivity (20% vs. 21.4%, P=0.48). At 2-year follow-up, 40 patients experienced major adverse cardiovascular events. The major adverse cardiovascular event rate was higher in anti-CagA IgG seropositive compared with seronegative patients (hazard ratio 2.25, 95% confidence interval 1.34-2.95, P=0.013), which was confirmed at Cox multivariate analysis (hazard ratio 2.33, 95% confidence interval 1.30-3.14, P=0.009). CONCLUSIONS: CagA-positive strains of Helicobacter pylori seem to be involved in the pathogenesis of recurring acute coronary syndromes, and seropositivity for anti-CagA IgG predicts prognosis after STEMI, possibly due to the increased risk of recurring cardiac events.

Niccoli, G., Roberto, M., D'amario, D., Scalone, G., Fracassi, F., Cosentino, N., Candelli, M., Franceschi, F., Crea, F., Cytotoxin-associated gene antigen-positive strains of Helicobacter pylori and recurring acute coronary syndromes, <<EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE>>, 2016; (JAN): N/A-N/A. [doi:10.1177/2048872615627708] [http://hdl.handle.net/10807/94695]

Cytotoxin-associated gene antigen-positive strains of Helicobacter pylori and recurring acute coronary syndromes

Niccoli, Giampaolo
Primo
;
D'Amario, Domenico;Scalone, Giancarla;Fracassi, Francesco;Cosentino, Nicola;Candelli, Marcello;Franceschi, Francesco
Penultimo
;
Crea, Filippo
Ultimo
2016

Abstract

BACKGROUND: Cytotoxin-associated gene antigen (CagA)-positive strains of Helicobacter pylori have previously been associated with acute coronary syndromes. However, the role of CagA-positive strains of Helicobacter pylori in recurring cardiac events after ST-segment elevation myocardial infarction (STEMI) has not yet been assessed. METHODS: We enrolled 181 consecutive patients (155 men, mean age 64±13 years) presenting with STEMI. In all patients, serum levels of IgG anti-CagA were assessed. Levels of IgG anti-hepatitis A virus were also evaluated in all patients in order to exclude the presence of a bystander activation of the immune system. Finally, a previous history of acute coronary syndrome and the rate of major adverse cardiovascular events as a composite of cardiovascular death, recurring myocardial infarction and target lesion revascularisation within 2 years follow-up were evaluated. RESULTS: Anti-CagA IgG seropositive patients presented more frequently with a previous history of acute coronary syndrome compared with seronegative patients (28.3% vs. 14%, P=0.019). Interestingly, no differences were observed between anti-CagA IgG seropositive and anti-CagA IgG seronegative patients concerning the prevalence of anti-hepatitis A virus IgG seropositivity (20% vs. 21.4%, P=0.48). At 2-year follow-up, 40 patients experienced major adverse cardiovascular events. The major adverse cardiovascular event rate was higher in anti-CagA IgG seropositive compared with seronegative patients (hazard ratio 2.25, 95% confidence interval 1.34-2.95, P=0.013), which was confirmed at Cox multivariate analysis (hazard ratio 2.33, 95% confidence interval 1.30-3.14, P=0.009). CONCLUSIONS: CagA-positive strains of Helicobacter pylori seem to be involved in the pathogenesis of recurring acute coronary syndromes, and seropositivity for anti-CagA IgG predicts prognosis after STEMI, possibly due to the increased risk of recurring cardiac events.
Inglese
Niccoli, G., Roberto, M., D'amario, D., Scalone, G., Fracassi, F., Cosentino, N., Candelli, M., Franceschi, F., Crea, F., Cytotoxin-associated gene antigen-positive strains of Helicobacter pylori and recurring acute coronary syndromes, <<EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE>>, 2016; (JAN): N/A-N/A. [doi:10.1177/2048872615627708] [http://hdl.handle.net/10807/94695]
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/10807/94695
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