Valor pronóstico de la respuesta serológica debida a Helicobacter pylori en la evolución a largo plazo del síndrome coronario agudo

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Abstract

Background
The serological response to Helicobacter pylori (HP) has been recognized as a cardiovascular risk factor. Yet, its prognostic usefulness in acute coronary syndromes (ACS) has not been extensively evaluated.

Objectives

To identify the prevalence and long-term prognosis of abnormalities in the level of IgG antibodies against HP (HP-
IgG) in patients with ACS.

Material and Methods

From April 2003 to December 2003, a total of 67 consecutive patients hospitalized due to ACS (unstable angina [UA], acute myocardial infarction [AMI]) within 24 hours from symptoms onset were evaluated using a commercial immunoassay kit (Meridian Diagnostics, USA).

Results
During follow-up (12±3 months) 10 (14.6%) events were reported (death/AMI/rehospitalization due to UA). The area under the ROC curve using HP-IgG to predict events was 0.85±0.06 (95% CI, 0.74-0.96); the cut-off point of 185 IU had a sensitivity of 70% and a specificity of 82%. Patients were divided into 2 groups: group 1 (HP-IgG >185 IU, 25.4%) and group 2 (HP-IgG <185 IU). Both groups were comparable. Annual survival free from events was 67% versus 90% in groups 1 and 2, respectively (log-rank test, p=0.01). The variables identified at admission as independent predictors of events were HP-IgG >185 UI (hazard ratio [HR]=5.588; p=0.039), hypotension (HR=1.109; p=0.035) and elevated creatinine levels (HR=1.997; p=0.019).

Conclusions

Early elevation of HP-IgG levels was present in 25% of patients with ACS and levels > 185 IU were associated with poor long-term outcomes.