title: Cytotoxin-associated gene antigen-positive strains of Helicobacter pylori and recurring acute coronary syndromes.
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.
authors.affiliation: 1 Institute of Cardiology, Catholic University of the Sacred Heart, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.affiliation: 1 Institute of Cardiology, Catholic University of the Sacred Heart, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Roberto
authors.affiliation: 1 Institute of Cardiology, Catholic University of the Sacred Heart, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: D'Amario
authors.affiliation: 1 Institute of Cardiology, Catholic University of the Sacred Heart, Italy.
authors.forename: Giancarla
authors.initials: G
authors.lastname: Scalone
authors.affiliation: 1 Institute of Cardiology, Catholic University of the Sacred Heart, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fracassi
authors.affiliation: 1 Institute of Cardiology, Catholic University of the Sacred Heart, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Cosentino
authors.affiliation: 2 Department of Emergency Medicine, Catholic University of the Sacred Heart, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Candelli
authors.affiliation: 3 Department of Internal Medicine and Gastroenterology, Catholic University of the Sacred Heart, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Franceschi
authors.affiliation: 1 Institute of Cardiology, Catholic University of the Sacred Heart, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D000942:Antigens, Bacterial / Q000276:immunology*; D001426:Bacterial Proteins / Q000276:immunology*; D015415:Biomarkers / Q000097:blood; D004562:Electrocardiography; D005260:Female; D016481:Helicobacter Infections / Q000097:blood / Q000150:complications* / Q000382:microbiology; D016480:Helicobacter pylori / Q000276:immunology* / Q000302:isolation & purification; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000942:Antigens, Bacterial; D001426:Bacterial Proteins; D015415:Biomarkers; C080866:cagA protein, Helicobacter pylori
keywords: ST-segment elevation myocardial infarction; cytotoxin associated gene antigen-positive strains of Helicobacter pylori; recurring cardiac events