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(Stroke. 2001;32:1936.)
© 2001 American Heart Association, Inc.

Letters to the Editor

Helicobacter pylori and Cerebrovascular Disease

William A. Ghali, MD, MPH; Hude Quan, MD, PhD Thomas E. Feasby, MD

Departments of Medicine and Community Health Sciences
Department of Community Health Sciences
Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada

To the Editor:

We are currently conducting a Canada-wide study of inhospital adverse events after carotid endarterectomy, and as part of that research we have performed analyses exploring associations between a variety of clinical variables and adverse events—specifically, inhospital death or postoperative stroke. These analyses demonstrate an association between peptic ulcer disease (PUD) and adverse events after carotid endarterectomy. We had initially dismissed this association as being spurious, perhaps due to the inevitable type I errors that arise when multiple variables are considered in such analyses. However, the recent paper in Stroke by Ameriso and colleagues¹ demonstrating Helicobacter pylori in human carotid plaques makes us wonder whether our finding is not, in fact, a "true" association.

We identified carotid endarterectomy cases across Canada by screening hospital discharge abstracts compiled by the Canadian Institute for Health Information for the presence of ICD-9-CM procedure code 50.12. The occurrence of inhospital death was determined from the "discharge alive" field in the discharge data, and postoperative stroke was identified by screening for diagnosis codes 997.0, 433, 434, 436, or 438 (for each of these, the associated ICD-9-CM diagnosis type indicator had to be coded as a "2," indicating that the corresponding diagnosis is a complication rather than a preexisting diagnosis). We defined a number of clinical risk variables, including PUD, using a published ICD-9-CM coding algorithm for defining comorbidities.²

Bivariate analyses reveal that patients with PUD present as a diagnosis at time of admission were more likely to experience adverse events than were patients without PUD (10.3% . . . [Full Text of this Article]

Sebastián F. Ameriso, MD; Ramón C. Leiguarda, MD Gustavo E. Sevlever, MD

Department of Neurology
Department of Neuropathology, Institute for Neurological Research (FLENI), Buenos Aires, Argentina