open access
Impact of air pollution on hospital patients admitted with ST- and non-ST-segment elevation myocardial infarction in heavily polluted cities within the European Union


- Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland
- University of Social Sciences, Poland
open access
Abstract
Background: Air pollution triggered diseases have become a leading health problem worldwide. The main adverse effects of air pollutants on human health are related to the cardiovascular system and particularly show an increasing prevalence of myocardial infarct and stroke. The aim of the study was to evaluate the influence of main air pollutants on non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI) admissions to local interventional
cardiology centers.
Methods: Between 2014 and 2015, a multicenter registry of 1957 patients with acute myocardial infarction (STEMI, NSTEMI) admitted to interventional cardiology departments in three Polish cities were under investigation. The air pollution (PM2.5, PM10, NO2, SO2, O3) and weather conditions (temperature, barometric pressure, humidity) data for each city were collected as daily averages. The case-crossover design and conditional logistic regression were used to explore the association between acute myocardial infarctions and short-term air pollution exposure.
Results: Occurrence of NSTEMI on the day of air pollution was triggered by PM2.5 (OR = 1.099, p = 0.01) and PM10 (OR = 1.078, p = 0.03). On the following day after the air pollution was recorded, NSTEMI was induced by: PM2.5 (OR = 1.093, p = 0.025), PM10 (OR = 1.077, p = 0.025) and SO2 (OR = 1.522, p = 0.009). For STEMI, events that occurred on the day in which air pollution was triggered by: PM2.5 (OR = 1.197, p < 0.001), PM10 (OR = 1.163, p < 0.001), SO2 (OR = 1.670, p = 0.001) and NO2 (OR = 1.287, p = 0.011). On the following day after air pollution was recorded, STEMI was induced by: PM2.5 (OR = 1.172, p < 0.001), PM10 (OR = 1.131, p = 0.001), SO2 (OR = 1.550, p = 0.005) and NO2 (OR = 1.265, p = 0.02). None of the weather conditions indicated were statistically significant for acute myocardial infarction occurrence.
Conclusions: The most important pollutants triggering acute myocardial infarction occurrence in the population of southern Poland, both on the day of air pollution and the following day are particulate matters (PM2.5, PM10) and gaseous pollutants including NO2 and SO2. These pollutants should be regarded as modifiable risk factors and thus, their reduction is a priority in order to decrease total morbidity and mortality in Poland.
Abstract
Background: Air pollution triggered diseases have become a leading health problem worldwide. The main adverse effects of air pollutants on human health are related to the cardiovascular system and particularly show an increasing prevalence of myocardial infarct and stroke. The aim of the study was to evaluate the influence of main air pollutants on non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI) admissions to local interventional
cardiology centers.
Methods: Between 2014 and 2015, a multicenter registry of 1957 patients with acute myocardial infarction (STEMI, NSTEMI) admitted to interventional cardiology departments in three Polish cities were under investigation. The air pollution (PM2.5, PM10, NO2, SO2, O3) and weather conditions (temperature, barometric pressure, humidity) data for each city were collected as daily averages. The case-crossover design and conditional logistic regression were used to explore the association between acute myocardial infarctions and short-term air pollution exposure.
Results: Occurrence of NSTEMI on the day of air pollution was triggered by PM2.5 (OR = 1.099, p = 0.01) and PM10 (OR = 1.078, p = 0.03). On the following day after the air pollution was recorded, NSTEMI was induced by: PM2.5 (OR = 1.093, p = 0.025), PM10 (OR = 1.077, p = 0.025) and SO2 (OR = 1.522, p = 0.009). For STEMI, events that occurred on the day in which air pollution was triggered by: PM2.5 (OR = 1.197, p < 0.001), PM10 (OR = 1.163, p < 0.001), SO2 (OR = 1.670, p = 0.001) and NO2 (OR = 1.287, p = 0.011). On the following day after air pollution was recorded, STEMI was induced by: PM2.5 (OR = 1.172, p < 0.001), PM10 (OR = 1.131, p = 0.001), SO2 (OR = 1.550, p = 0.005) and NO2 (OR = 1.265, p = 0.02). None of the weather conditions indicated were statistically significant for acute myocardial infarction occurrence.
Conclusions: The most important pollutants triggering acute myocardial infarction occurrence in the population of southern Poland, both on the day of air pollution and the following day are particulate matters (PM2.5, PM10) and gaseous pollutants including NO2 and SO2. These pollutants should be regarded as modifiable risk factors and thus, their reduction is a priority in order to decrease total morbidity and mortality in Poland.
Keywords
air pollution, myocardial infarction, non-ST-segment elevation myocardial infarction (NSTEMI), ST-segment elevation myocardial infarction (STEMI)


Title
Impact of air pollution on hospital patients admitted with ST- and non-ST-segment elevation myocardial infarction in heavily polluted cities within the European Union
Journal
Issue
Pages
541-547
Published online
2018-12-13
Page views
2185
Article views/downloads
1702
DOI
10.5603/CJ.a2018.0156
Pubmed
Bibliographic record
Cardiol J 2020;27(5):541-547.
Keywords
air pollution
myocardial infarction
non-ST-segment elevation myocardial infarction (NSTEMI)
ST-segment elevation myocardial infarction (STEMI)
Authors
Paweł E. Buszman
Kamil Derbisz
Przemysław Kwasiborski
Patrycja Chrząszcz
Magdalena Mularska
Dominika Baron
Anna Sobieszek
Artur Mendyk
Paweł Skoczylas
Marek Cisowski
Piotr P. Buszman
Krzysztof Milewski


- World Health Organization, World Health Assembly closes, passing resolutions on air pollution and epilepsy. 2015.
- World Health Organization, Ambient (outdoor) air quality and health. 2016.
- Mustafić H, Jabre P, Caussin C, et al. Main air pollutants and myocardial infarction: a systematic review and meta-analysis. JAMA. 2012; 307(7): 713.
- Newby DE, Mannucci PM, Tell GS, et al. ESC Working Group on Thrombosis, Rehabilitation, E.S.C.H.F. Association.Expert position paper on air pollution and cardiovascular disease. Eur Heart J. 2015; 36(2): 83–93b.
- Yin F, Lawal A, Ricks J, et al. Diesel exhaust induces systemic lipid peroxidation and development of dysfunctional pro-oxidant and pro-inflammatory high-density lipoprotein. Arterioscler Thromb Vasc Biol. 2013; 33(6): 1153–1161.
- Claeys MJ, Rajagopalan S, Nawrot RD. Brook, Climate and environmental triggers of acute myocardial infarction. Eur Heart J. 2017; 38(13): 955–960.
- Kriszbacher I, Bodis J, Csoboth I, et al. The occurrence of acute myocardial infarction in relation to weather conditions. Int J Cardiol. 2009; 135(1): 136–138.
- Bhaskaran K, Hajat S, Haines A, et al. Effects of ambient temperature on the incidence of myocardial infarction. Heart. 2009; 95(21): 1760–1769.
- Houck P, Lethen J, Riggs M, et al. Relation of Atmospheric Pressure Changes and the Occurrences of Acute Myocardial Infarction and Stroke. Am J Cardiol. 2005; 96(1): 45–51.
- World Health Organization, World Health Statistics. 2017.
- World Health Organization. 2016.
- Maclure M. The case-crossover design: a method for studying transient effects on the risk of acute events. Am J Epidemiol. 1991; 133(2): 144–153.
- Statistical Bulletin. 2017.
- Cai X, Li Z, Scott EM. Short-term effects of atmospheric particulate matter on myocardial infarction: a cumulative meta-analysis. Environ Sci Pollut Res Int. 2016; 23(7): 6139–6148.
- Argacha JF, Collart P, Wauters A, et al. Air pollution and ST-elevation myocardial infarction: A case-crossover study of the Belgian STEMI registry 2009-2013. Int J Cardiol. 2016; 223: 300–305.
- Pope CA, Muhlestein JB, Anderson JL, et al. Short-Term Exposure to Fine Particulate Matter Air Pollution Is Preferentially Associated With the Risk of ST-Segment Elevation Acute Coronary Events. J Am Heart Assoc. 2015; 4(12).
- Butland BK, Atkinson RW, Milojevic Ai, et al. Myocardial infarction, ST-elevation and non-ST-elevation myocardial infarction and modelled daily pollution concentrations: a case-crossover analysis of MINAP data. Open Heart. 2016; 3(2): e000429.